# MIMI'S WIG BOUTIQUE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184928756
- **Authorized official:** MR. RICHARD D VINCENT (PRESIDENT)
- **Authorized official phone:** (972) 392-9968

## Contact information

- **Practice address:** 7522 CAMPBELL RD STE 112, DALLAS, TX 75248-1726
- **Practice address phone:** (972) 380-5306
- **Mailing address:** 13626 PEYTON DR, DALLAS, TX 75240-5524
- **Mailing address phone:** (972) 392-9968

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | TX | Yes |

## Other

- **Enumeration date:** 12/22/2010
- **Last updated:** 12/22/2010