Provider Demographics
NPI:1154454999
Name:WAIN, ALISA HOPE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:HOPE
Last Name:WAIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1494
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-1494
Mailing Address - Country:US
Mailing Address - Phone:609-903-6615
Mailing Address - Fax:
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BLDG #4, SUITE E
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:609-895-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1018471001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics