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General NPI Number Information
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NPI Number | 1144836453
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Entity Type | Organization
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Legal Business Name | GLOW DENTAL AND ORTHODONTICS PLLC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 2572 GUS THOMASSON RD
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City | DALLAS
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State | TX
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Zip | 75228-3017
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Country | US
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Telephone | 214-699-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 EMPIRE CENTRAL PL STE 112
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City | DALLAS
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State | TX
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Zip | 75247-4312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RAHUL JOSHI
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Credential | DDS
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Telephone | 480-747-5129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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