Provider Demographics
NPI:1457529901
Name:WRIGHT, CHARLES REESE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:REESE
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 1:1280 W LANTANA RD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1543
Mailing Address - Country:US
Mailing Address - Phone:561-588-1919
Mailing Address - Fax:561-588-2687
Practice Address - Street 1:1280 W LANTANA RD
Practice Address - Street 2:SUITE #8
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1543
Practice Address - Country:US
Practice Address - Phone:561-588-1919
Practice Address - Fax:561-588-2687
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN7350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist