=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316180821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIAVASH EFTEKHARI DMD, M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2009
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 WEST LEBANON RD. SUITE 128
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-349-9122
-----------------------------------------------------
Fax | 817-500-5032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 255 WEST LEBANON RD. SUITE 128
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-349-9122
-----------------------------------------------------
Fax | 817-500-5032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | Q3507
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number | 31061
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------