Provider Demographics
NPI:1467190413
Name:GLOW DENTAL, LLC
Entity Type:Organization
Organization Name:GLOW DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-762-1470
Mailing Address - Street 1:6510 GARDENWICK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2538
Mailing Address - Country:US
Mailing Address - Phone:443-762-1470
Mailing Address - Fax:
Practice Address - Street 1:7636 BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-663-1073
Practice Address - Fax:410-663-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty