Healthcare Provider Details

I. General information

NPI: 1053802702
Provider Name (Legal Business Name): KIMIA EFTEKHAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 REDSTONE DR STE 500
INDIAN LAND SC
29707-5402
US

IV. Provider business mailing address

8170 S TRYON ST STE C
CHARLOTTE NC
28273-3354
US

V. Phone/Fax

Practice location:
  • Phone: 803-753-1349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number102412
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9471
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: