Provider Demographics
NPI:1215277850
Name:RAYMOND L WRIGHT III DDS PC
Entity type:Organization
Organization Name:RAYMOND L WRIGHT III DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-531-1562
Mailing Address - Street 1:365 N JEFFERSON
Mailing Address - Street 2:#1801
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:365 N JEFFERSON ST
Practice Address - Street 2:#1801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1226
Practice Address - Country:US
Practice Address - Phone:773-531-1562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty