Healthcare Provider Details

I. General information

NPI: 1700780806
Provider Name (Legal Business Name): PREVITA ORAL HEALTH INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAIN ST
GORHAM ME
04038-1319
US

IV. Provider business mailing address

439 US ROUTE 1 STE A
YORK ME
03909-1638
US

V. Phone/Fax

Practice location:
  • Phone: 781-518-1334
  • Fax:
Mailing address:
  • Phone: 781-518-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DIEGO BARBOSA DA SILVA
Title or Position: DENTAL HYGIENIST
Credential: RDH, IPDH
Phone: 781-518-1334