Active NPI
Masoud Eghtedari, DDS
- Prosthodontics
- Jacksonville, FL
National Provider Identifier
1982676508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 4777
- Practice address
- BLDG H 2005 Knight Lane
Navy Medicine Support Command Attn: Medical Staff SVCS
Jacksonville, FL 32212-0140 - Phone
- (858) 577-4725
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 4777 | LA | Primary |
Addresses
Primary practice location
BLDG H 2005 Knight Lane
Navy Medicine Support Command Attn: Medical Staff SVCS
Jacksonville, FL 32212-0140
Mailing address
PSC 819 Box18-328
Fpo Ae, SPAIN 09645
ES
Phone 01134956823768
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 |
|---|---|---|---|
| 4777 | LA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233619200000",
"number": "1982676508",
"addresses": [
{
"country_code": "ES",
"country_name": "Spain",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "PSC 819 BOX18-328",
"city": "FPO AE",
"state": "SPAIN",
"postal_code": "09645",
"telephone_number": "01134956823768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLDG H 2005 KNIGHT LANE",
"address_2": "NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322120140",
"telephone_number": "858-577-4725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EGHTEDARI",
"first_name": "MASOUD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-07",
"last_updated": "2009-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "LA",
"license": "4777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.