Provider Demographics
NPI:1780769117
Name:WRIGHT, GARRY CRAIG (DMD)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:CRAIG
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 1:3839 COUNTY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:NOTASULGA
Mailing Address - State:AL
Mailing Address - Zip Code:36866-3447
Mailing Address - Country:US
Mailing Address - Phone:334-257-1256
Mailing Address - Fax:
Practice Address - Street 1:106A 16TH PL
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5634
Practice Address - Country:US
Practice Address - Phone:334-745-0119
Practice Address - Fax:334-745-0280
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDD3986OtherBOARD OF DENTAL EXAMININERS OF ALABAMA CERTIFICATE NUMBER