Provider Demographics
NPI:1811171218
Name:DYNAMIC DESIGN HAIR AND BODY WORKS
Entity type:Organization
Organization Name:DYNAMIC DESIGN HAIR AND BODY WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-664-2727
Mailing Address - Street 1:1178 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3042
Mailing Address - Country:US
Mailing Address - Phone:810-664-2727
Mailing Address - Fax:810-667-2727
Practice Address - Street 1:1178 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3042
Practice Address - Country:US
Practice Address - Phone:810-664-2727
Practice Address - Fax:810-667-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
540D410660OtherBCBS
540D410660OtherBCBS