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General NPI Number Information
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NPI Number | 1629882519
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Entity Type | Organization
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Legal Business Name | GLIMMER ORTHODONTICS PLLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 25 PELHAM RD STE 104
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City | SALEM
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State | NH
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Zip | 03079-4872
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Country | US
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Telephone | 603-912-7878
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Fax | 603-912-7572
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Provider Business Mailing Address
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Address Line | 25 PELHAM RD STE 104
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City | SALEM
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State | NH
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Zip | 03079-4872
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Country | US
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Telephone | 603-912-7878
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Fax | 603-912-7572
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JI HYUN TAHK
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Credential | DMD, MS
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Telephone | 603-912-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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