Provider Demographics
NPI:1134259039
Name:WRIGHT, TERRY WAYNE (DMD PSC)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:WAYNE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DMD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1421
Mailing Address - Street 2:118 CAROLINE AVENUE
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-1421
Mailing Address - Country:US
Mailing Address - Phone:606-437-1942
Mailing Address - Fax:606-437-9886
Practice Address - Street 1:118 CAROLINE AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41502-1421
Practice Address - Country:US
Practice Address - Phone:606-437-1942
Practice Address - Fax:606-437-9886
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY63581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
60063583Medicare UPIN