Healthcare Provider Details

I. General information

NPI: 1982808648
Provider Name (Legal Business Name): CHAD M WRIGHT DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4481 LAS POSAS RD STE C
CAMARILLO CA
93010-2537
US

IV. Provider business mailing address

4481 LAS POSAS RD STE C
CAMARILLO CA
93010-2537
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-1688
  • Fax: 805-484-1044
Mailing address:
  • Phone: 805-484-1688
  • Fax: 805-484-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number45998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: