Organization
ELEGANT SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SASAN KHODABAKHSH D.D.S (DENTIST/OWNER/PRESIDENT)
(972) 735-8900
Entity
Organization
Contact information
Practice address
17610 MIDWAY RD STE 110, DALLAS, TX 75287-6741
(972) 735-8900
Mailing address
17610 MIDWAY RD STE 110, DALLAS, TX 75287-6741
(972) 735-8900
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22300
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1732828-09
—
TX
Enumeration date
09/10/2010
Last updated
09/10/2010
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