Provider Demographics
NPI:1871064055
Name:CAPTIVATING GLAM SALON LLC
Entity type:Organization
Organization Name:CAPTIVATING GLAM SALON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:D'NELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-352-8411
Mailing Address - Street 1:12021 DALLAS PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3605
Mailing Address - Country:US
Mailing Address - Phone:469-352-8411
Mailing Address - Fax:
Practice Address - Street 1:12021 DALLAS PKWY STE 600
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3605
Practice Address - Country:US
Practice Address - Phone:469-352-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment