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General NPI Number Information
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NPI Number | 1629682349
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Entity Type | Organization
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Legal Business Name | TALA EFTEKHARI DENTAL CORPORATION
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 4955 VAN NUYS BLVD STE 716
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1843
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Country | US
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Telephone | 813-625-4147
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Fax |
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Provider Business Mailing Address
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Address Line | 10747 WILSHIRE BLVD APT 1308
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City | LOS ANGELES
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State | CA
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Zip | 90024-4409
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Country | US
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Telephone | 813-625-4147
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TALA EFTEKHARI
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Credential | DDS
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Telephone | 813-625-4147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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