Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | Q3507 | TX |
N | 2086S0122X | Plastic and Reconstructive Surgery | Q3507 | TX |
NPI | 1316180821 |
---|---|
Provider Name | Dr. Siavash Eftekhari |
First Address | Fort Worth, TX 76104-7635 |
Second Address | Fort Worth, TX 76104-7635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2009 |
Last Update Date | 22/05/2017 |