Provider Demographics
NPI:1568764595
Name:PREVENTION WORKS
Entity Type:Organization
Organization Name:PREVENTION WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-949-2963
Mailing Address - Street 1:92 SHAW HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-3402
Mailing Address - Country:US
Mailing Address - Phone:207-949-2963
Mailing Address - Fax:
Practice Address - Street 1:92 SHAW HILL RD
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-3402
Practice Address - Country:US
Practice Address - Phone:207-949-2963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2650124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty