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General NPI Number Information
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NPI Number | 1659691616
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Entity Type | Individual
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Provider Name | ABRAK ETEMAD DMD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 09/12/2024
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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 |
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Provider Business Mailing Address
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Address Line | 535 TULAROSA
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City | IRVINE
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State | CA
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Zip | 92618-1117
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Country | US
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Telephone | 949-562-9616
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 63271
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7977
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License Number State | AZ
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