Provider Demographics
NPI:1558185322
Name:NTEKIM, ETTE ETIM (DDS)
Entity type:Individual
Prefix:DR
First Name:ETTE
Middle Name:ETIM
Last Name:NTEKIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 W GONZALES RD STE 250
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0728
Mailing Address - Country:US
Mailing Address - Phone:213-256-9561
Mailing Address - Fax:
Practice Address - Street 1:451 W GONZALES RD STE 250
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0728
Practice Address - Country:US
Practice Address - Phone:213-256-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1108011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice