Provider Demographics
NPI:1831248079
Name:WRIGHT, SCOTT DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
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 1:256 TECUMSEH LN
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2225
Mailing Address - Country:US
Mailing Address - Phone:813-766-3942
Mailing Address - Fax:
Practice Address - Street 1:113 LIELMANIS AVE BLDG 91020
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544
Practice Address - Country:US
Practice Address - Phone:850-884-7881
Practice Address - Fax:850-881-3404
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7545122300000X
PR3154122300000X
FLDN152551223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist