Provider Demographics
NPI:1477039592
Name:ETEMADI, NAEEM (DDS)
Entity type:Individual
Prefix:
First Name:NAEEM
Middle Name:
Last Name:ETEMADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 BERNARDO PLAZA CT STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2426
Mailing Address - Country:US
Mailing Address - Phone:858-633-1110
Mailing Address - Fax:858-633-1331
Practice Address - Street 1:11770 BERNARDO PLAZA CT STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2426
Practice Address - Country:US
Practice Address - Phone:858-633-1110
Practice Address - Fax:858-633-1331
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1031971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice