Provider Demographics
NPI:1831164623
Name:WRIGHT, FREDERICK V (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:V
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 1:11402 SARATOGA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-8314
Mailing Address - Country:US
Mailing Address - Phone:502-498-4663
Mailing Address - Fax:
Practice Address - Street 1:5220 DIXIE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1704
Practice Address - Country:US
Practice Address - Phone:502-449-7995
Practice Address - Fax:502-449-2028
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice