=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518247998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARLENE M. WRIGHT DDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2011
-----------------------------------------------------
Last Update Date | 08/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10025 GOVERNOR WARFIELD PKWY STE 217
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21044-3340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-730-6121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10025 GOVERNOR WARFIELD PKWY SUITE 217
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21044-3340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-730-6121
-----------------------------------------------------
Fax | 410-730-5547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KARLENE MARIE WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-730-6121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12974
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------