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General NPI Number Information
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NPI Number | 1215277850
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Entity Type | Organization
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Legal Business Name | RAYMOND L WRIGHT III DDS PC
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 365 N JEFFERSON ST #1801
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City | CHICAGO
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State | IL
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Zip | 60661-1226
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Country | US
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Telephone | 773-531-1562
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Fax |
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Provider Business Mailing Address
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Address Line | 365 N JEFFERSON #1801
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City | CHICAGO
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State | IL
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Zip | 60661
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYMOND LEROY WRIGHT III
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Credential | D.D.S.
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Telephone | 773-531-1562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019026720
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License Number State | IL
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