Provider Demographics
NPI:1134569247
Name:WRIGHT, ROBERTA ANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:ANNE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 QUARRY LN
Mailing Address - Street 2:APT 1214
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7786
Mailing Address - Country:US
Mailing Address - Phone:815-603-3804
Mailing Address - Fax:
Practice Address - Street 1:8 QUARRY LN
Practice Address - Street 2:APT 1214
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-7786
Practice Address - Country:US
Practice Address - Phone:815-603-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572411223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics