Provider Demographics
NPI:1639493778
Name:OPULENCE HAIR SALON, PLLC
Entity Type:Organization
Organization Name:OPULENCE HAIR SALON, PLLC
Other - Org Name:OPULENCE SALON & DAY SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-299-0806
Mailing Address - Street 1:902 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4115
Mailing Address - Country:US
Mailing Address - Phone:360-299-0806
Mailing Address - Fax:360-299-0806
Practice Address - Street 1:902 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4115
Practice Address - Country:US
Practice Address - Phone:360-299-0806
Practice Address - Fax:360-299-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty