Provider Demographics
NPI:1629882519
Name:GLIMMER ORTHODONTICS PLLC
Entity type:Organization
Organization Name:GLIMMER ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JI
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:TAHK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:603-912-7878
Mailing Address - Street 1:25 PELHAM RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4872
Mailing Address - Country:US
Mailing Address - Phone:603-912-7878
Mailing Address - Fax:603-912-7572
Practice Address - Street 1:25 PELHAM RD STE 104
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4872
Practice Address - Country:US
Practice Address - Phone:603-912-7878
Practice Address - Fax:603-912-7572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH04811OtherDENTAL LICENSE