Healthcare Provider Details

I. General information

NPI: 1700529336
Provider Name (Legal Business Name): DALLIN WRIGHT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 10/09/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 6180 BOX 245
APO AE
09603
US

IV. Provider business mailing address

31 MEDICAL GROUP AVIANO AB 31 MEDICAL GROUP / SGST UNIT 6180
APO AE
09604-6180
US

V. Phone/Fax

Practice location:
  • Phone: 314-632-3972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00205274
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: