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General NPI Number Information
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NPI Number | 1912561952
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Entity Type | Organization
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Legal Business Name | PINK VANITY BEAUTY BAR LLC
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 16990 DALLAS PKWY STE 208
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City | DALLAS
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State | TX
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Zip | 75248-1935
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Country | US
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Telephone | 682-302-0037
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Fax |
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Provider Business Mailing Address
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Address Line | 16990 DALLAS PKWY STE 208
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City | DALLAS
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State | TX
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Zip | 75248-1935
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. SYREETA WILLIAMS
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Credential | HLP
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Telephone | 972-707-0708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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