Provider Demographics
NPI:1154419026
Name:WRIGHT, WILSON JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:
Last Name:WRIGHT
Suffix:JR
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 1:524 RED LANE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-8245
Mailing Address - Country:US
Mailing Address - Phone:205-410-6576
Mailing Address - Fax:205-836-4311
Practice Address - Street 1:524 RED LANE RD
Practice Address - Street 2:SUITE F
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-8245
Practice Address - Country:US
Practice Address - Phone:205-836-4044
Practice Address - Fax:205-836-4311
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009968360Medicaid