Provider Demographics
NPI:1871181693
Name:WRIGHT, DANTA ROGER
Entity Type:Individual
Prefix:
First Name:DANTA
Middle Name:ROGER
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 W STADIUM BLVD UNIT 1703
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-7726
Mailing Address - Country:US
Mailing Address - Phone:734-846-2916
Mailing Address - Fax:734-270-6381
Practice Address - Street 1:2075 W STADIUM BLVD UNIT 1703
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106-7726
Practice Address - Country:US
Practice Address - Phone:734-846-2916
Practice Address - Fax:734-270-6381
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service