Provider Demographics
NPI:1861646689
Name:EFTEKHARI RIZI, MINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:EFTEKHARI RIZI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 ATLANTIC AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2833
Mailing Address - Country:US
Mailing Address - Phone:562-426-9308
Mailing Address - Fax:562-426-9300
Practice Address - Street 1:4301 ATLANTIC AVE STE 4
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2833
Practice Address - Country:US
Practice Address - Phone:562-426-9308
Practice Address - Fax:562-426-9300
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist