Organization
MIMI'S WIG BOUTIQUE
Active
Organization
MIMI'S WIG BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD DEAN VINCENT (PRESIDENT)
(972) 392-9968
Entity
Organization
Contact information
Practice address
7522 CAMPBELL RD STE 112, DALLAS, TX 75248-1726
(972) 380-5306
Mailing address
13626 PEYTON DR, DALLAS, TX 75240-5524
(972) 392-9968
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/16/2006
Last updated
08/22/2020
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