Provider Demographics
NPI:1962882878
Name:WRIGHT, STEPHEN (PEDIATRIC DENTIST)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PEDIATRIC DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9927 PENNEYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8793
Mailing Address - Country:US
Mailing Address - Phone:423-315-6828
Mailing Address - Fax:
Practice Address - Street 1:10 ARLEY WAY STE 102
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4883
Practice Address - Country:US
Practice Address - Phone:843-757-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9711122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist