MEDICARE: DHAIR BOUTIQUE INTERNATIONAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1629647078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DHAIR BOUTIQUE INTERNATIONAL LLC

Provider Business Mailing Address
First Line	:	7602 CAMPBELL RD # 13
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1704
Country	:	US
Telephone Number	:	214-923-1261
Fax Number	:

Provider Business Practice Location Address
First Line	:	7602 CAMPBELL RD # 13
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1704
Country	:	US
Telephone Number	:	214-923-1261
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	D ANDREA DENISE HARRIS
Credential	:
Telephone Number	:	214-923-1261

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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Directions to “DHAIR BOUTIQUE INTERNATIONAL LLC ” Practice Location

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