Provider Demographics
NPI:1417581240
Name:ELEGANT DENTISTRY PPLC
Entity Type:Organization
Organization Name:ELEGANT DENTISTRY PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAHSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKABBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-217-2712
Mailing Address - Street 1:6545 FRANCE AVE S STE 681
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2127
Mailing Address - Country:US
Mailing Address - Phone:612-800-8008
Mailing Address - Fax:612-353-4246
Practice Address - Street 1:6545 FRANCE AVE S STE 681
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2127
Practice Address - Country:US
Practice Address - Phone:612-800-8008
Practice Address - Fax:612-353-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty