Provider Demographics
NPI:1912738345
Name:A WIG CENTER
Entity type:Organization
Organization Name:A WIG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-225-4620
Mailing Address - Street 1:83 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-225-4620
Mailing Address - Fax:603-415-1002
Practice Address - Street 1:83 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-225-4620
Practice Address - Fax:603-415-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier