The Classic Wig Bar

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

THE CLASSIC WIG BAR

Practice address

20250 N 67TH Ave Apt 2107
Glendale, AZ 85308-6640

Phone

(205) 703-6679

NPI assigned

Jul 15, 2024

Last updated

Jul 15, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shante Jackson

Title

Ceo

Phone

(205) 703-6679

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1326886375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15331 W BELL RD STE 2",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853744102",
            "telephone_number": "623-257-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20250 N 67TH AVE APT 2107",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086640",
            "telephone_number": "205-703-6679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CLASSIC WIG BAR",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SHANTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-703-6679"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.