Provider Demographics
NPI:1215284393
Name:ETEBARI, PARYA (DDS)
Entity type:Individual
Prefix:
First Name:PARYA
Middle Name:
Last Name:ETEBARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 OLD SHEPARD PL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2823
Mailing Address - Country:US
Mailing Address - Phone:214-535-9554
Mailing Address - Fax:
Practice Address - Street 1:12398 FM 423
Practice Address - Street 2:SUITE 1900
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4758
Practice Address - Country:US
Practice Address - Phone:214-436-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry