Provider Demographics
NPI:1316949902
Name:WRIGHT, RAYMOND LEROY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LEROY
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:LEROY
Other - Last Name:WRIGHT, JR DDS PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1001 AVENIDA PICO STE K
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6956
Mailing Address - Country:US
Mailing Address - Phone:949-361-4867
Mailing Address - Fax:949-361-4868
Practice Address - Street 1:1001 AVENIDA PICO STE K
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6956
Practice Address - Country:US
Practice Address - Phone:949-361-4867
Practice Address - Fax:949-361-4868
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79831223P0300X
CA630631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics