Provider Demographics
NPI:1376063909
Name:WRIGHT, KELSEY JORDYN ALEXANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:JORDYN ALEXANDRA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4315
Mailing Address - Country:US
Mailing Address - Phone:931-363-6441
Mailing Address - Fax:
Practice Address - Street 1:403 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4315
Practice Address - Country:US
Practice Address - Phone:931-363-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000107981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice