Healthcare Provider Details

I. General information

NPI: 1710725791
Provider Name (Legal Business Name): XCLUSIVE CLOZURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4752 FISHBURG RD STE C
DAYTON OH
45424-5455
US

IV. Provider business mailing address

4752 FISHBURG RD STE C
DAYTON OH
45424-5455
US

V. Phone/Fax

Practice location:
  • Phone: 937-219-5012
  • Fax:
Mailing address:
  • Phone: 937-219-5012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KIONA DAVIS
Title or Position: WIGMAKER
Credential:
Phone: 937-219-5012