Provider Demographics
NPI:1679394704
Name:DENTA GLOW CORP
Entity type:Organization
Organization Name:DENTA GLOW CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ASMAA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:551-242-4420
Mailing Address - Street 1:17 BUTTERNUT ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4851
Mailing Address - Country:US
Mailing Address - Phone:551-242-4420
Mailing Address - Fax:
Practice Address - Street 1:2787 JOHN F KENNEDY BLVD # A13
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5531
Practice Address - Country:US
Practice Address - Phone:551-242-4420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental