Provider Demographics
NPI:1629453642
Name:A. ROY WRATHER, D.D.S.
Entity Type:Organization
Organization Name:A. ROY WRATHER, D.D.S.
Other - Org Name:WRATHER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-476-8121
Mailing Address - Street 1:720 W SHERROD AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3024
Mailing Address - Country:US
Mailing Address - Phone:901-476-8121
Mailing Address - Fax:901-476-7573
Practice Address - Street 1:720 W SHERROD AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3024
Practice Address - Country:US
Practice Address - Phone:901-476-8121
Practice Address - Fax:901-476-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty