Provider Demographics
NPI:1972017606
Name:CONCEPT ONE HAIR DYNAMICS
Entity Type:Organization
Organization Name:CONCEPT ONE HAIR DYNAMICS
Other - Org Name:ROBERT A COLOMBO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:HAIR STYLIST
Authorized Official - Phone:508-872-0001
Mailing Address - Street 1:680 WORCESTER RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5259
Mailing Address - Country:US
Mailing Address - Phone:508-872-0001
Mailing Address - Fax:
Practice Address - Street 1:680 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5259
Practice Address - Country:US
Practice Address - Phone:508-872-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20021332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20021OtherLOCATION LICENSE