| Elegant Smiles Dentistry | |
|
4775 Knights Bridge Blvd. Columbus OH 43214 | |
| (614) 824-5454 | |
| Not Available |
| Full Name | Elegant Smiles Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4775 Knights Bridge Blvd., Columbus, Ohio |
| Authorized Official Name and Position | Ali Khaksarfard (DENTIST/OWNER) |
| Authorized Official Contact | 6148245454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elegant Smiles Dentistry 4775 Knights Bridge Blvd. Columbus OH 43214 Ph: (614) 824-5454 | Elegant Smiles Dentistry 4775 Knights Bridge Blvd. Columbus OH 43214 Ph: (614) 824-5454 |
| NPI Number | 1740629039 |
|---|---|
| Provider Enumeration Date | 06/19/2013 |
| Last Update Date | 06/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740629039 | NPI | - | NPPES |
| 2417772 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 21821 (Ohio) | Primary |
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