Healthcare Provider Details

I. General information

NPI: 1639869266
Provider Name (Legal Business Name): DORIN WIGS&HAIR EXTENSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4572 SW 29TH TER
FORT LAUDERDALE FL
33312-5615
US

IV. Provider business mailing address

4572 SW 29TH TER
FORT LAUDERDALE FL
33312-5615
US

V. Phone/Fax

Practice location:
  • Phone: 305-975-7990
  • Fax:
Mailing address:
  • Phone: 305-975-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DORIN BARUCH
Title or Position: REGISTERED AGENT
Credential:
Phone: 305-975-7990