Provider Demographics
NPI:1659085272
Name:BEFORE & AFTER HAIR SALON, LLC
Entity Type:Organization
Organization Name:BEFORE & AFTER HAIR SALON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIR LOSS
Authorized Official - Phone:601-661-8326
Mailing Address - Street 1:1808 S FRONTAGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5263
Mailing Address - Country:US
Mailing Address - Phone:601-661-8326
Mailing Address - Fax:
Practice Address - Street 1:1808 S FRONTAGE RD STE 1
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5263
Practice Address - Country:US
Practice Address - Phone:601-661-8326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier