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Organization
ETEMADI DENTAL CORPORATION
Active
Organization
ETEMADI DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHASHAYAR ETEMADI DDS (PRESIDENT)
(909) 899-8757
Entity
Organization
Contact information
Practice address
12729 FOOTHILL BLVD, SUITE # A, RANCHO CUCAMONGA, CA 91739-9334
(909) 899-8757
(909) 899-8760
Mailing address
12729 FOOTHILL BLVD, SUITE # A, RANCHO CUCAMONGA, CA 91739-9334
(909) 899-8757
(909) 899-8760
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
868675
UNITED CONCORDIA
CA
01
—
G9124301
MEDICAL
CA
Enumeration date
11/29/2006
Last updated
10/13/2021
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