Healthcare Provider Details

I. General information

NPI: 1336458694
Provider Name (Legal Business Name): WHITNEY BOYLE WRIGHT DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2794 CORTLAND AVE
GRAND JUNCTION CO
81506-8435
US

IV. Provider business mailing address

2794 CORTLAND AVE
GRAND JUNCTION CO
81506-8435
US

V. Phone/Fax

Practice location:
  • Phone: 720-299-9903
  • Fax:
Mailing address:
  • Phone: 720-299-9903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8179
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10013
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: