Provider Demographics
NPI:1326257361
Name:WRIGHT, GREGORY BOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BOB
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 1:200 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6238
Mailing Address - Country:US
Mailing Address - Phone:817-481-7999
Mailing Address - Fax:817-421-2465
Practice Address - Street 1:200 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 30
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6238
Practice Address - Country:US
Practice Address - Phone:817-481-7999
Practice Address - Fax:817-421-2465
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice