Organization
JUDAH
Active
Other names
Hair Envy Cranial Prothesis
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DORETHA BESSEMER (OWNER)
(616) 643-3848
Entity
Organization
Contact information
Practice address
2975 WATERCHASE WAY SW SUITE 307, WYOMING, MI 49519
(616) 643-3848
Mailing address
2975 WATERCHASE WAY SW SUITE 307, WYOMING, MI 49519
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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