1407208887 NPI number — ROBERTA A. WRIGHT, DMD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407208887 NPI number — ROBERTA A. WRIGHT, DMD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERTA A. WRIGHT, DMD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407208887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 QUARRY LN
Provider Second Line Business Mailing Address:
APT 1214
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02148-7786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-603-3804
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 QUARRY LN
Provider Second Line Business Practice Location Address:
APT 1214
Provider Business Practice Location Address City Name:
MALDEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02148-7786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-603-3804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
PROSTHODONTIST
Authorized Official Telephone Number:
815-603-3804

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  DN1857241 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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