Provider Demographics
NPI:1124685789
Name:GROOMING ARTS LOUNGE AND GALLERY
Entity type:Organization
Organization Name:GROOMING ARTS LOUNGE AND GALLERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAZUAN
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:JUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-399-2064
Mailing Address - Street 1:19520 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7112
Mailing Address - Country:US
Mailing Address - Phone:313-399-2064
Mailing Address - Fax:
Practice Address - Street 1:19520 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7112
Practice Address - Country:US
Practice Address - Phone:313-399-2064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty