Provider Demographics
NPI:1669556429
Name:WRIGHT, CLARK J (DMD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 WOODMERE PARK BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2205
Mailing Address - Country:US
Mailing Address - Phone:941-493-5923
Mailing Address - Fax:
Practice Address - Street 1:4140 WOODMERE PARK BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2205
Practice Address - Country:US
Practice Address - Phone:941-493-5923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL79781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice