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General NPI Number Information
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NPI Number | 1164043444
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Entity Type | Organization
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Legal Business Name | HAIR SEW GORGEOUS
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 2021 N HAMPTON RD STE 160
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City | DESOTO
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State | TX
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Zip | 75115-8625
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Country | US
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Telephone | 972-998-2202
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Fax | 214-833-5627
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Provider Business Mailing Address
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Address Line | 104 E OVILLA RD UNIT 35
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City | RED OAK
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State | TX
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Zip | 75154-9203
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Country | US
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Telephone | 972-998-2202
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Fax | 214-833-5627
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Authorized Official
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Title or Position | OWNER
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Name | DONDRA WOMACK
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Credential |
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Telephone | 972-998-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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