# ELEGANT SMILES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417264524
- **Authorized official:** MR. SASAN KHODABAKHSH D.D.S (DENTIST/OWNER/PRESIDENT)
- **Authorized official phone:** (972) 735-8900

## Contact information

- **Practice address:** 17610 MIDWAY RD STE 110, DALLAS, TX 75287-6741
- **Practice address phone:** (972) 735-8900
- **Mailing address:** 17610 MIDWAY RD STE 110, DALLAS, TX 75287-6741
- **Mailing address phone:** (972) 735-8900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22300 | TX | Yes |

## Other

- **Enumeration date:** 09/10/2010
- **Last updated:** 09/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1732828-09 | — | TX |