Healthcare Provider Details

I. General information

NPI: 1376460824
Provider Name (Legal Business Name): LEWIS RANDALL WRIGHT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 3RD ST
LA GRANDE OR
97850-2244
US

IV. Provider business mailing address

62019 STARR LN
LA GRANDE OR
97850-5366
US

V. Phone/Fax

Practice location:
  • Phone: 541-963-0924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12372
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: