MEDICARE: DORIN WIGS&HAIR EXTENSIONS 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	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1639869266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORIN WIGS&HAIR EXTENSIONS LLC

Provider Business Mailing Address
First Line	:	4572 SW 29TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5615
Country	:	US
Telephone Number	:	305-975-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	4572 SW 29TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5615
Country	:	US
Telephone Number	:	305-975-7990
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	DORIN BARUCH
Credential	:
Telephone Number	:	305-975-7990

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	10/20/2025

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