Provider Demographics
NPI:1588165567
Name:WRIGHT, AMANDA (RDHAP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 LAUGHLIN WAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-6424
Mailing Address - Country:US
Mailing Address - Phone:707-391-3227
Mailing Address - Fax:
Practice Address - Street 1:9240 LAUGHLIN WAY
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-6424
Practice Address - Country:US
Practice Address - Phone:707-391-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA677124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist