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General NPI Number Information
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NPI Number | 1528567575
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Entity Type | Organization
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Legal Business Name | DR. MASSOUD EFTEKHARI
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 830 S MAIN ST STE 1D
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4621
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Country | US
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Telephone | 928-634-5566
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Fax | 928-634-5566
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Provider Business Mailing Address
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Address Line | 14524 N 106TH PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-8595
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Country | US
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Telephone | 602-430-8462
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Fax | 928-634-1363
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MASSOUD EFTEKHARI
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Credential | DDS
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Telephone | 602-430-8462
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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 | 4954
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License Number State | AZ
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