Provider Demographics
NPI:1154434595
Name:CHARLES R WRIGHT DDS, PA
Entity type:Organization
Organization Name:CHARLES R WRIGHT DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-588-1919
Mailing Address - Street 1:1280 LANTANA RD
Mailing Address - Street 2:#8
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1543
Mailing Address - Country:US
Mailing Address - Phone:561-588-1919
Mailing Address - Fax:561-588-2687
Practice Address - Street 1:1280 LANTANA RD
Practice Address - Street 2:#8
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1543
Practice Address - Country:US
Practice Address - Phone:561-588-1919
Practice Address - Fax:561-588-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN7350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty