Organization
FACIAL HEAD & NECK SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIAVASH EFTEKHARI MD, DMD (SOLE MBR)
(503) 866-3780
Entity
Organization
Contact information
Practice address
2317 COIT RD STE A, PLANO, TX 75075-3774
(618) 541-2864
(817) 500-5032
Mailing address
1202 S ADAMS ST, FORT WORTH, TX 76104-4428
(503) 866-3780
(817) 500-5032
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
2086X0206X
Surgical Oncology Physician
Primary
—
—
Other
Enumeration date
01/13/2017
Last updated
01/13/2017
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