MEDICARE: DR. ABBAS EFTEKHARI D. D. S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	41402	CA

General Provider Information

NPI Number	:	1316915382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABBAS EFTEKHARI D. D. S.

Provider Business Mailing Address
First Line	:	3909 SEPULVEDA BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4607
Country	:	US
Telephone Number	:	310-390-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 SEPULVEDA BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4607
Country	:	US
Telephone Number	:	310-390-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/08/2007

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