Healthcare Provider Details

I. General information

NPI: 1639975527
Provider Name (Legal Business Name): TDBI HAIR REPLACEMENT SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8174 LAS VEGAS BLVD S STE 101
LAS VEGAS NV
89123-1030
US

IV. Provider business mailing address

4200 HARRIS AVE
LAS VEGAS NV
89110-2224
US

V. Phone/Fax

Practice location:
  • Phone: 702-720-3812
  • Fax:
Mailing address:
  • Phone: 702-720-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: THOMAS SIMMS
Title or Position: CRANIAL PROSTHETICS SPECIALIST
Credential:
Phone: 702-720-3812