Provider Demographics
NPI:1124290689
Name:WRIGHT, PETER C (DMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WEST EMERSON STREET
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3110
Mailing Address - Country:US
Mailing Address - Phone:781-665-5222
Mailing Address - Fax:781-665-4832
Practice Address - Street 1:12 WEST EMERSON STREET
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3110
Practice Address - Country:US
Practice Address - Phone:781-665-5222
Practice Address - Fax:781-665-4832
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice