Organization
EXTRAVAGANT HAIR STUDIO
Active
Organization
EXTRAVAGANT HAIR STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BENNETTA JOYCE REYNOLDS (HAIR PROSTHESIS SPECIALIST)
(216) 323-9969
Entity
Organization
Contact information
Practice address
12810 MILLS BREEZE DR, HOUSTON, TX 77070-1381
(216) 323-9969
Mailing address
12810 MILLS BREEZE DR, HOUSTON, TX 77070-1381
(216) 323-9969
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
1420593
TX
Other
Enumeration date
09/06/2016
Last updated
09/06/2016
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