Provider Demographics
NPI:1194062489
Name:HEIDEH EFTEHARI, DDS
Entity type:Organization
Organization Name:HEIDEH EFTEHARI, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:EFTEHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-323-3830
Mailing Address - Street 1:1001 BROADWAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4397
Mailing Address - Country:US
Mailing Address - Phone:206-323-3830
Mailing Address - Fax:206-322-0152
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:SUITE 209
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4397
Practice Address - Country:US
Practice Address - Phone:206-323-3830
Practice Address - Fax:206-322-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty