Provider Demographics
NPI:1912531583
Name:WRIGHT, ASIA-BRYANNE CAROLINE
Entity type:Individual
Prefix:
First Name:ASIA-BRYANNE
Middle Name:CAROLINE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4064
Mailing Address - Country:US
Mailing Address - Phone:479-452-4333
Mailing Address - Fax:
Practice Address - Street 1:6600 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4064
Practice Address - Country:US
Practice Address - Phone:479-452-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX369261223G0001X
AR45961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice