Provider Demographics
NPI:1083977938
Name:WRIGHT, MIRANDA DENISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:DENISE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 COUNTY ROAD 220
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4908
Mailing Address - Country:US
Mailing Address - Phone:904-215-3533
Mailing Address - Fax:904-264-8783
Practice Address - Street 1:1605 COUNTY ROAD 220
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4908
Practice Address - Country:US
Practice Address - Phone:904-215-3533
Practice Address - Fax:904-264-8783
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist