Provider Demographics
NPI:1437309622
Name:ELEGANT DENTAL
Entity Type:Organization
Organization Name:ELEGANT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:NHI
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-497-5999
Mailing Address - Street 1:1809 ELDRIDGE PARKWAY STE.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077
Mailing Address - Country:US
Mailing Address - Phone:281-497-5999
Mailing Address - Fax:
Practice Address - Street 1:1809 ELDRIDGE PARKWAY
Practice Address - Street 2:216
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077
Practice Address - Country:US
Practice Address - Phone:281-497-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty