# GLOW DENTAL SPA P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033587381
- **Authorized official:** BEHSHAD AHKAMI D.D.S. (DOCTOR)
- **Authorized official phone:** (973) 942-6550

## Contact information

- **Practice address:** 506 HAMBURG TPKE, SUITE 101, WAYNE, NJ 07470-2068
- **Practice address phone:** (973) 942-6550
- **Practice address fax:** (973) 942-6553
- **Mailing address:** 506 HAMBURG TPKE, SUITE 101, WAYNE, NJ 07470-2068
- **Mailing address phone:** (973) 942-6550
- **Mailing address fax:** (973) 942-6553

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DI020826 | NJ | Yes |

## Other

- **Enumeration date:** 09/03/2015
- **Last updated:** 09/03/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 24362NJ | — | NJ |