Provider Demographics
NPI:1114943834
Name:WRIGHT, CARL ALFONSO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:ALFONSO
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 1:8390 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-3735
Mailing Address - Country:US
Mailing Address - Phone:850-494-7150
Mailing Address - Fax:850-494-7151
Practice Address - Street 1:9673 GRALLATORIAL CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-7204
Practice Address - Country:US
Practice Address - Phone:850-497-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 150821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071883100Medicaid