Provider Demographics
NPI:1689302838
Name:SLAYEDLOCKS LLC
Entity Type:Organization
Organization Name:SLAYEDLOCKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:EMELIA
Authorized Official - Middle Name:ADIONNE
Authorized Official - Last Name:NWOKOBIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-903-5389
Mailing Address - Street 1:5218 URBAN CREST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-1530
Mailing Address - Country:US
Mailing Address - Phone:972-903-5389
Mailing Address - Fax:
Practice Address - Street 1:5218 URBAN CREST RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1530
Practice Address - Country:US
Practice Address - Phone:972-903-5389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1836253OtherTDLR COSMETOLOGY LICENSE