Provider Demographics
NPI:1811283690
Name:WRIGHT, TODD CLARK (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:CLARK
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 1:575 S 200 E
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-2310
Mailing Address - Country:US
Mailing Address - Phone:435-232-2631
Mailing Address - Fax:
Practice Address - Street 1:575 S 200 E
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2310
Practice Address - Country:US
Practice Address - Phone:435-232-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT846991871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics