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General NPI Number Information
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NPI Number | 1881418739
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Entity Type | Organization
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Legal Business Name | FOREVER BARE ELECTROLYSIS
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 6464 E NORTHWEST HWY STE 127
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City | DALLAS
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State | TX
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Zip | 75214-7804
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Country | US
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Telephone | 469-494-5840
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Fax |
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Provider Business Mailing Address
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Address Line | 7311 WAKE FORREST DR
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City | DALLAS
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State | TX
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Zip | 75214-1750
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Country | US
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Telephone | 469-494-5840
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Fax |
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Authorized Official
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Title or Position | OWNER/ELECTROLOGIST
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Name | ERICA MORENO
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Credential | CPE
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Telephone | 469-494-5840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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