Provider Demographics
NPI:1245620319
Name:WRIGHT BROTHERS ORTHODONTICS PC
Entity Type:Organization
Organization Name:WRIGHT BROTHERS ORTHODONTICS PC
Other - Org Name:WRIGHT ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DUKE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-789-5070
Mailing Address - Street 1:806 W 100 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2423
Mailing Address - Country:US
Mailing Address - Phone:435-789-5070
Mailing Address - Fax:435-789-5005
Practice Address - Street 1:806 W 100 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2423
Practice Address - Country:US
Practice Address - Phone:435-789-5070
Practice Address - Fax:435-789-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT37434099211223X0400X
UT846918799211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty