Provider Demographics
NPI:1295374734
Name:AGLOW DENTAL STUDIO
Entity Type:Organization
Organization Name:AGLOW DENTAL STUDIO
Other - Org Name:AGLOW DENTAL PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:AHANOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-651-6130
Mailing Address - Street 1:11150 SUNSET HILLS RD STE 303
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11150 SUNSET HILLS RD STE 303
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5335
Practice Address - Country:US
Practice Address - Phone:703-651-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental