MEDICARE: ELEGANT DENTAL RICHMOND, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1053180778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEGANT DENTAL RICHMOND, PLLC

Provider Business Mailing Address
First Line	:	1023 WILLIAMS LAKE DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4295
Country	:	US
Telephone Number	:	310-709-3734
Fax Number	:

Provider Business Practice Location Address
First Line	:	5614 W GRAND PKWY S STE 120
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5820
Country	:	US
Telephone Number	:	918-280-8309
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. MOIZ U HORANI
Credential	:	DDS
Telephone Number	:	918-280-8309

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	12/21/2023

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