Healthcare Provider Details

I. General information

NPI: 1376941880
Provider Name (Legal Business Name): TANYA WRIGHT D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13065 E 17TH AVE
AURORA CO
80045-2532
US

IV. Provider business mailing address

13065 E 17TH AVE
AURORA CO
80045-2532
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-3697
  • Fax:
Mailing address:
  • Phone: 303-724-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS0000008292
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDN1856798
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDEN00205359
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: