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General NPI Number Information
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NPI Number | 1467190413
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Entity Type | Organization
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Legal Business Name | GLOW DENTAL, LLC
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Dates
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Enumeration Date | 05/20/2022
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 7636 BELAIR RD
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City | NOTTINGHAM
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State | MD
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Zip | 21236-4088
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Country | US
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Telephone | 410-663-1073
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Fax | 410-663-1072
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Provider Business Mailing Address
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Address Line | 6510 GARDENWICK RD
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City | BALTIMORE
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State | MD
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Zip | 21209-2538
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Country | US
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Telephone | 443-762-1470
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAYAM NOURMAND
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Credential |
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Telephone | 443-762-1470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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