Healthcare Provider Details

I. General information

NPI: 1457397754
Provider Name (Legal Business Name): HEIDEH EFTEKHARI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDEH EFTEHARI DDS

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE SUITE 1500
SEATTLE WA
98104-3595
US

IV. Provider business mailing address

3230 78TH PLACE NE
MEDINA WA
98039
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-3830
  • Fax: 206-322-0152
Mailing address:
  • Phone: 425-453-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6748
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: