Healthcare Provider Details

I. General information

NPI: 1659524692
Provider Name (Legal Business Name): MASSOUD EFTEKHARI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S MAIN ST STE 1D
COTTONWOOD AZ
86326-4621
US

IV. Provider business mailing address

14524 N 106TH PL
SCOTTSDALE AZ
85255-8595
US

V. Phone/Fax

Practice location:
  • Phone: 602-430-8462
  • Fax: 928-634-1363
Mailing address:
  • Phone: 602-430-8462
  • Fax: 928-634-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4954
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4954
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: