MEDICARE: DR. CAMILLE WRIGHT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN25305	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235748831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMILLE WRIGHT DMD

Provider Business Mailing Address
First Line	:	2145 MESA GRANDE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-2041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 SOLANA RD
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2297
Country	:	US
Telephone Number	:	904-280-1717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	07/29/2020

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