Healthcare Provider Details

I. General information

NPI: 1457660151
Provider Name (Legal Business Name): SAMIN EFTEKHARI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13431 TELEGRAPH RD
WHITTIER CA
90605-3435
US

IV. Provider business mailing address

29 MICHELANGELO
ALISO VIEJO CA
92656-1476
US

V. Phone/Fax

Practice location:
  • Phone: 562-946-2838
  • Fax:
Mailing address:
  • Phone: 305-609-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number61253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: