Provider Demographics
NPI:1134755218
Name:DOPE BEAUTY BAR LLC
Entity type:Organization
Organization Name:DOPE BEAUTY BAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / STYLIST
Authorized Official - Prefix:
Authorized Official - First Name:TIARA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-666-1115
Mailing Address - Street 1:1459 LIGHT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4549
Mailing Address - Country:US
Mailing Address - Phone:754-666-1115
Mailing Address - Fax:
Practice Address - Street 1:1459 LIGHT ST STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4549
Practice Address - Country:US
Practice Address - Phone:754-666-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier