Active NPI
Tandis Eftekhari, DMD
- Dentist
- Newport Beach, CA
National Provider Identifier
1063628816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 52048
- Practice address
- 2105 San Joaquin Hills Rd
Newport Beach, CA 92660-6507 - Phone
- (949) 721-1730
- Fax
- (949) 721-1709
- NPI assigned
- May 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 52048 | CA | Primary |
Addresses
Primary practice location
2105 San Joaquin Hills Rd
Newport Beach, CA 92660-6507
Mailing address
2105 San Joaquin Hills Rd
Newport Beach, CA 92660-6507
Phone (949) 721-1730
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52048 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349049600000",
"number": "1063628816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2105 SAN JOAQUIN HILLS RD",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926606507",
"telephone_number": "949-721-1730",
"fax_number": "949-721-1709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2105 SAN JOAQUIN HILLS RD",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926606507",
"telephone_number": "949-721-1730",
"fax_number": "949-721-1709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EFTEKHARI",
"first_name": "TANDIS",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2012-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "52048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.