NPIMap

Individual provider Active NPI

Massoud Eftekhari, DDS

  • General Practice Dentistry
  • Cottonwood, AZ
National Provider Identifier
1659524692
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4954 Issued in AZ
Practice address
830 S Main St Ste 1D
Cottonwood, AZ 86326-4621
Phone
(602) 430-8462
Fax
(928) 634-1363
NPI assigned
Nov 3, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 4954 AZ
General Practice Dentistry 1223G0001X 4954 AZ Primary

Addresses

Primary practice location

830 S Main St Ste 1D
Cottonwood, AZ 86326-4621

Mailing address

14524 N 106TH PL
Scottsdale, AZ 85255-8595
Phone (602) 430-8462

Other practice location 1

650 W Maryland Ave
#2
Phoenix, AZ 85013-1399
Phone (602) 249-1616

Other identifiers 2

IdentifierTypeStateIssuer
4954OtherAZDENTIST LICENSE
496932MedicaidAZ

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Massoud Eftekhari General Practice Past Accepting new patients
Maryland Garden Dental Past Accepting new patients
Cottonwood Dental Associates PLLC Dentist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1659524692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14524 N 106TH PL",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852558595",
            "telephone_number": "602-430-8462",
            "fax_number": "928-634-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S MAIN ST STE 1D",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264621",
            "telephone_number": "602-430-8462",
            "fax_number": "928-634-1363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 W Maryland Ave",
            "address_2": "#2",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850131399",
            "country_code": "US",
            "telephone_number": "602-249-1616",
            "fax_number": "602-249-1138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EFTEKHARI",
        "first_name": "MASSOUD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "4954",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "4954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST LICENSE",
            "identifier": "4954",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "496932",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottonwood, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.