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General NPI Number Information
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NPI Number | 1063115970
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Entity Type | Organization
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Legal Business Name | ETEMAD DENTAL INC
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Dates
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Enumeration Date | 03/22/2023
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 5010 CAMPUS DR STE 130
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2120
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Country | US
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Telephone | 949-945-6262
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Fax | 949-945-6266
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Provider Business Mailing Address
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Address Line | 5010 CAMPUS DR STE 130
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2120
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Country | US
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Telephone | 949-945-6262
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Fax | 949-945-6266
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | DR. ABRAK ETEMAD
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Credential | DMD
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Telephone | 949-562-9616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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