Provider Demographics
NPI:1477902989
Name:MAGGIE WRIGHT FETNER, DDS, PLLC
Entity Type:Organization
Organization Name:MAGGIE WRIGHT FETNER, DDS, PLLC
Other - Org Name:RANDOLPH PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FETNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-963-2408
Mailing Address - Street 1:202 N COX ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5526
Mailing Address - Country:US
Mailing Address - Phone:336-382-9038
Mailing Address - Fax:
Practice Address - Street 1:202 N COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5526
Practice Address - Country:US
Practice Address - Phone:336-382-9038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty