Provider Demographics
NPI:1811545650
Name:SALON BAR LLC
Entity Type:Organization
Organization Name:SALON BAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-431-2791
Mailing Address - Street 1:3482 JOHNSON FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5214
Mailing Address - Country:US
Mailing Address - Phone:561-271-7306
Mailing Address - Fax:
Practice Address - Street 1:4705 ASHFORD DUNWOODY RD # 4
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5566
Practice Address - Country:US
Practice Address - Phone:404-431-2791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier