Provider Demographics
NPI:1518661578
Name:LUMINOUS SMILE, CORP.
Entity Type:Organization
Organization Name:LUMINOUS SMILE, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:240-549-2015
Mailing Address - Street 1:2500 WATERSIDE DR UNIT 212
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3257
Mailing Address - Country:US
Mailing Address - Phone:240-549-2015
Mailing Address - Fax:
Practice Address - Street 1:605 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3930
Practice Address - Country:US
Practice Address - Phone:240-549-2015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental