Provider Demographics
NPI:1053180778
Name:ELEGANT DENTAL RICHMOND, PLLC
Entity type:Organization
Organization Name:ELEGANT DENTAL RICHMOND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOIZ
Authorized Official - Middle Name:U
Authorized Official - Last Name:HORANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-280-8309
Mailing Address - Street 1:1023 WILLIAMS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4295
Mailing Address - Country:US
Mailing Address - Phone:310-709-3734
Mailing Address - Fax:
Practice Address - Street 1:5614 W GRAND PKWY S STE 120
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5820
Practice Address - Country:US
Practice Address - Phone:918-280-8309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELEGANT DENTAL SOLUTIONS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty