Provider Demographics
NPI:1730625740
Name:FACIAL HEAD & NECK SURGERY PLLC
Entity type:Organization
Organization Name:FACIAL HEAD & NECK SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:EFTEKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:503-866-3780
Mailing Address - Street 1:1202 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4428
Mailing Address - Country:US
Mailing Address - Phone:503-866-3780
Mailing Address - Fax:817-500-5032
Practice Address - Street 1:2317 COIT RD STE A
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3774
Practice Address - Country:US
Practice Address - Phone:618-541-2864
Practice Address - Fax:817-500-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty