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General NPI Number Information
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NPI Number | 1720751456
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Entity Type | Organization
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Legal Business Name | GLOWSMILES
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 9433 ANNAPOLIS RD
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City | LANHAM
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State | MD
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Zip | 20706-3020
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Country | US
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Telephone | 412-953-8928
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Fax |
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Provider Business Mailing Address
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Address Line | 327 SCHERER LN
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1828
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Country | US
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Telephone | 412-953-8928
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | REZA GHAJARNIA
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Credential |
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Telephone | 412-953-8928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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