Healthcare Provider Details

I. General information

NPI: 1629882519
Provider Name (Legal Business Name): GLIMMER ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PELHAM RD STE 104
SALEM NH
03079-4872
US

IV. Provider business mailing address

25 PELHAM RD STE 104
SALEM NH
03079-4872
US

V. Phone/Fax

Practice location:
  • Phone: 603-912-7878
  • Fax: 603-912-7572
Mailing address:
  • Phone: 603-912-7878
  • Fax: 603-912-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JI HYUN TAHK
Title or Position: OWNER DENTIST
Credential: DMD, MS
Phone: 603-912-7878