Provider Demographics
NPI:1518264910
Name:WOBURN HAIRMATE SALON INC.
Entity Type:Organization
Organization Name:WOBURN HAIRMATE SALON INC.
Other - Org Name:HAIRMATE SALON & WIGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MITRANO
Authorized Official - Suffix:
Authorized Official - Credentials:HAIRDRESSER
Authorized Official - Phone:781-938-0495
Mailing Address - Street 1:454 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4236
Mailing Address - Country:US
Mailing Address - Phone:781-938-0495
Mailing Address - Fax:781-933-1477
Practice Address - Street 1:454 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4236
Practice Address - Country:US
Practice Address - Phone:781-938-0495
Practice Address - Fax:781-933-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1098492332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies