Provider Demographics
NPI:1184708877
Name:WRIGHT, RANDALL I (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:I
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MOUNTAIN ST
Mailing Address - Street 2:SUITE 3G ROSS BUILDING
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3822
Mailing Address - Country:US
Mailing Address - Phone:775-883-7244
Mailing Address - Fax:775-883-7083
Practice Address - Street 1:1001 MOUNTAIN ST
Practice Address - Street 2:SUITE 3G ROSS BUILDING
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3822
Practice Address - Country:US
Practice Address - Phone:775-883-7244
Practice Address - Fax:775-883-7083
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist