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General NPI Number Information
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NPI Number | 1982676508
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Entity Type | Individual
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Provider Name | MASOUD EGHTEDARI DDS
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | BLDG H 2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS
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City | JACKSONVILLE
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State | FL
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Zip | 32212-0140
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Country | US
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Telephone | 858-577-4725
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 819 BOX18-328
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City | FPO AE
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State | SPAIN
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Zip | 09645
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Country | ES
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Telephone | 01134956823768
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 4777
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License Number State | LA
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