Provider Demographics
NPI:1336905058
Name:DEBONAIR SALON LLC
Entity Type:Organization
Organization Name:DEBONAIR SALON LLC
Other - Org Name:DEBONAIR SALON LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SALON MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:904-723-4416
Mailing Address - Street 1:5301 NORWOOD AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-5006
Mailing Address - Country:US
Mailing Address - Phone:904-723-4416
Mailing Address - Fax:
Practice Address - Street 1:5301 NORWOOD AVE STE 14
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5006
Practice Address - Country:US
Practice Address - Phone:904-258-7397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty