Provider Demographics
NPI:1215034129
Name:BAGLEY, DWIGHT ENGLISH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:ENGLISH
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DWIGHT
Other - Middle Name:ENGLISH
Other - Last Name:BAGLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4555 BRIMMER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7798
Mailing Address - Country:US
Mailing Address - Phone:336-774-2329
Mailing Address - Fax:
Practice Address - Street 1:201 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1507
Practice Address - Country:US
Practice Address - Phone:336-718-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics