Provider Demographics
NPI:1780834457
Name:WRIGHT, NICOLE R (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
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 1:3809 FORRESTGATE DR STE A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2982
Mailing Address - Country:US
Mailing Address - Phone:336-768-9010
Mailing Address - Fax:336-768-9011
Practice Address - Street 1:3809 FORRESTGATE DR STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2982
Practice Address - Country:US
Practice Address - Phone:336-768-9010
Practice Address - Fax:336-768-9011
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91301223P0300X
NC85601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics