Healthcare Provider Details

I. General information

NPI: 1417880584
Provider Name (Legal Business Name): BAWSEHAIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 W PARKER RD STE B124
PLANO TX
75075-9102
US

IV. Provider business mailing address

2828 W PARKER RD STE B124
PLANO TX
75075-9102
US

V. Phone/Fax

Practice location:
  • Phone: 803-972-1744
  • Fax:
Mailing address:
  • Phone: 803-972-1744
  • 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: SHEDRICIQUA WHITE
Title or Position: FOUNDER
Credential:
Phone: 803-972-1744