MEDICARE: DIANE RAGGARD WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN9081	FL

General Provider Information

NPI Number	:	1538356258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE RAGGARD WRIGHT

Provider Business Mailing Address
First Line	:	3714 W EUCLID AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3714 W EUCLID AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8725
Country	:	US
Telephone Number	:	813-882-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	01/25/2011

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