Organization
FANTASY HAIR & BRAIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESULA LONGCHAMP CO,CPS (MANAGER)
(214) 853-1950
Entity
Organization
Contact information
Practice address
5208 AIRPORT FWY STE 170, HALTOM CITY, TX 76117-5922
(214) 853-1950
Mailing address
705 CHICKASAW TRCE, GRAND PRAIRIE, TX 75051-2916
(214) 853-1950
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
03/06/2023
Last updated
03/06/2023
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