Provider Demographics
NPI:1033694484
Name:WRIGHT, GARY JOE (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JOE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 MADISINA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2639
Mailing Address - Country:US
Mailing Address - Phone:512-223-5717
Mailing Address - Fax:
Practice Address - Street 1:3401 WEBBERVILLE RD RM 8149
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3004
Practice Address - Country:US
Practice Address - Phone:512-223-5717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice