MEDICARE: DR. MASSOUD EFTEKHARI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4954	AZ
2	1223G0001X	General Practice Dentistry	4954	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4954	OTHER	AZ	DENTIST LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659524692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASSOUD EFTEKHARI DDS

Provider Business Mailing Address
First Line	:	14524 N 106TH PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-8595
Country	:	US
Telephone Number	:	602-430-8462
Fax Number	:	928-634-1363

Provider Business Practice Location Address
First Line	:	830 S MAIN ST STE 1D
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4621
Country	:	US
Telephone Number	:	602-430-8462
Fax Number	:	928-634-1363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	03/17/2018

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