Provider Demographics
NPI:1104231547
Name:WRIGHT, ASHLEY P (DMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:P
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2012
Mailing Address - Country:US
Mailing Address - Phone:706-657-7575
Mailing Address - Fax:706-657-2958
Practice Address - Street 1:13570 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2012
Practice Address - Country:US
Practice Address - Phone:706-657-7575
Practice Address - Fax:706-657-2958
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003148509CMedicaid
GA003148509AMedicaid
GA003148509BMedicaid
GA003148509BMedicaid
GA111024Medicare Oscar/Certification
GA111960Medicare Oscar/Certification