Provider Demographics
NPI:1720751456
Name:GLOWSMILES
Entity Type:Organization
Organization Name:GLOWSMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAJARNIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-953-8928
Mailing Address - Street 1:327 SCHERER LN
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1828
Mailing Address - Country:US
Mailing Address - Phone:412-953-8928
Mailing Address - Fax:
Practice Address - Street 1:9433 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3020
Practice Address - Country:US
Practice Address - Phone:412-953-8928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty