Provider Demographics
NPI:1689268526
Name:DOTSON, GLINDA S (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:GLINDA
Middle Name:S
Last Name:DOTSON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 N 62ND ST # A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4119
Mailing Address - Country:US
Mailing Address - Phone:414-551-9047
Mailing Address - Fax:
Practice Address - Street 1:5110 N 62ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4119
Practice Address - Country:US
Practice Address - Phone:414-551-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment