Organization
XQUISITE XTENSIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA CANNON COSMETOLOGIST (OWNER)
(704) 527-0200
Entity
Organization
Contact information
Practice address
2805 SOUTH BLVD, CHARLOTTE, NC 28209-1801
(704) 527-0200
Mailing address
2805 SOUTH BLVD, CHARLOTTE, NC 28209-1801
(704) 527-0200
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
NC92801
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C92801
COSMETOLGY
NC
Enumeration date
03/12/2015
Last updated
03/12/2015
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