Provider Demographics
NPI:1457397754
Name:EFTEKHARI, HEIDEH (DDS)
Entity Type:Individual
Prefix:
First Name:HEIDEH
Middle Name:
Last Name:EFTEKHARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HEIDEH
Other - Middle Name:
Other - Last Name:EFTEHARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3230 78TH PLACE NE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039
Mailing Address - Country:US
Mailing Address - Phone:425-453-9615
Mailing Address - Fax:
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3595
Practice Address - Country:US
Practice Address - Phone:206-323-3830
Practice Address - Fax:206-322-0152
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA67481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice