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General NPI Number Information
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NPI Number | 1235107079
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Entity Type | Organization
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Legal Business Name | UPLAND DENTAL PRACTICE
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 270 E 7TH ST SUITE 2D
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City | UPLAND
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State | CA
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Zip | 91786-6602
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Country | US
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Telephone | 909-920-6000
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Fax | 909-985-6070
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Provider Business Mailing Address
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Address Line | 270 E 7TH ST SUITE 2D
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City | UPLAND
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State | CA
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Zip | 91786-6602
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Country | US
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Telephone | 909-920-6000
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Fax | 909-985-6070
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Authorized Official
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Title or Position | OWNER
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Name | DR. ABBAS EFTEKHARI
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Credential | D. D. S.
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Telephone | 909-920-6000
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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 | 4991
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License Number State | CA
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