Provider Demographics
NPI:1396061453
Name:WRIGHT, JAY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 W BUCKSKIN TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-4302
Mailing Address - Country:US
Mailing Address - Phone:951-551-3733
Mailing Address - Fax:866-479-2701
Practice Address - Street 1:7757 W DEER VALLEY RD
Practice Address - Street 2:STE 260
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2118
Practice Address - Country:US
Practice Address - Phone:602-284-5163
Practice Address - Fax:623-444-4822
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308561223X0400X
AZ4975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics