Provider Demographics
NPI:1407208887
Name:ROBERTA A. WRIGHT, DMD, PC
Entity Type:Organization
Organization Name:ROBERTA A. WRIGHT, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MDSC
Authorized Official - Phone:815-603-3804
Mailing Address - Street 1:8 QUARRY LN
Mailing Address - Street 2:APT 1214
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7786
Mailing Address - Country:US
Mailing Address - Phone:815-603-3804
Mailing Address - Fax:
Practice Address - Street 1:8 QUARRY LN
Practice Address - Street 2:APT 1214
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-7786
Practice Address - Country:US
Practice Address - Phone:815-603-3804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572411223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty