Provider Demographics
NPI:1619021318
Name:EFTEKHARZADEH, SINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SINA
Middle Name:
Last Name:EFTEKHARZADEH
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 1:655 S MAIN ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4690
Mailing Address - Country:US
Mailing Address - Phone:714-543-2815
Mailing Address - Fax:
Practice Address - Street 1:655 S MAIN ST
Practice Address - Street 2:SUITE 230
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4690
Practice Address - Country:US
Practice Address - Phone:714-543-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice