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General NPI Number Information
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NPI Number | 1871999532
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Entity Type | Individual
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Provider Name | GEORGE RANDALL WRIGHT DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 2550 W FABYAN PKWY
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City | BATAVIA
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State | IL
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Zip | 60510-1572
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Country | US
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Telephone | 630-208-1200
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Fax | 630-402-0378
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Provider Business Mailing Address
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Address Line | 2550 W FABYAN PKWY
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City | BATAVIA
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State | IL
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Zip | 60510-1572
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Country | US
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Telephone | 630-208-1200
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Fax | 630-402-0378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019024145
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021002022
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License Number State | IL
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