| Elegant Smiles | |
|
17610 Midway Rd Ste 110 Dallas TX 75287-6741 | |
| (972) 735-8900 | |
| Not Available |
| Full Name | Elegant Smiles |
|---|---|
| Speciality | Dentist |
| Location | 17610 Midway Rd Ste 110, Dallas, Texas |
| Authorized Official Name and Position | Sasan Khodabakhsh (DENTIST/OWNER/PRESIDENT) |
| Authorized Official Contact | 9727358900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elegant Smiles 17610 Midway Rd Ste 110 Dallas TX 75287-6741 Ph: (972) 735-8900 | Elegant Smiles 17610 Midway Rd Ste 110 Dallas TX 75287-6741 Ph: (972) 735-8900 |
| NPI Number | 1417264524 |
|---|---|
| Provider Enumeration Date | 09/10/2010 |
| Last Update Date | 09/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417264524 | NPI | - | NPPES |
| 1732828-09 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 22300 (Texas) | Primary |
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