Elegant Smiles

Primary specialty

DentistTaxonomy code 122300000X

License

22300 Issued in TX

Legal business name

ELEGANT SMILES

Practice address

17610 Midway Rd Ste 110
Dallas, TX 75287-6741

Phone

(972) 735-8900

NPI assigned

Sep 10, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Sasan Khodabakhsh, D.D.S

Title

Dentist/Owner/President

Phone

(972) 735-8900

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1417264524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17610 MIDWAY RD STE 110",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752876741",
            "telephone_number": "972-735-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17610 MIDWAY RD STE 110",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752876741",
            "telephone_number": "972-735-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEGANT SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-10",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "KHODABAKHSH",
        "authorized_official_first_name": "SASAN",
        "authorized_official_title_or_position": "DENTIST/OWNER/PRESIDENT",
        "authorized_official_telephone_number": "972-735-8900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "22300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1732828-09",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.