Elegant Smiles Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

21821 Issued in OH

Legal business name

ELEGANT SMILES DENTISTRY

Practice address

4775 Knights Bridge Blvd.
Columbus, OH 43214

Phone

(614) 824-5454

NPI assigned

Jun 19, 2013

Last updated

Jun 19, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ali Khaksarfard, DDS

Title

Dentist/Owner

Phone

(614) 824-5454

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371600000000",
    "number": "1740629039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4775 KNIGHTS BRIDGE BLVD.",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43214",
            "telephone_number": "614-824-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 KNIGHTS BRIDGE BLVD.",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43214",
            "telephone_number": "614-824-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEGANT SMILES DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2013-06-19",
        "status": "A",
        "authorized_official_last_name": "KHAKSARFARD",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "614-824-5454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OH",
            "license": "21821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2417772",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Columbus, OH
• Providers in Columbus, OH by specialty
• Dental Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; 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.