Provider Demographics
NPI:1063115970
Name:ETEMAD DENTAL INC
Entity type:Organization
Organization Name:ETEMAD DENTAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ETEMAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-562-9616
Mailing Address - Street 1:5010 CAMPUS DR STE 130
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2120
Mailing Address - Country:US
Mailing Address - Phone:949-945-6262
Mailing Address - Fax:949-945-6266
Practice Address - Street 1:5010 CAMPUS DR STE 130
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2120
Practice Address - Country:US
Practice Address - Phone:949-945-6262
Practice Address - Fax:949-945-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty