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Organization

ELEGANT SMILES DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALI KHAKSARFARD DDS (DENTIST/OWNER)
(614) 824-5454
Entity
Organization

Contact information

Practice address
4775 KNIGHTS BRIDGE BLVD., COLUMBUS, OH 43214
(614) 824-5454
Mailing address
4775 KNIGHTS BRIDGE BLVD., COLUMBUS, OH 43214
(614) 824-5454

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
21821
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2417772
OH
Enumeration date
06/19/2013
Last updated
06/19/2013
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