MEDICARE: NICOLE R WRIGHT D.D.S.

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	1223P0300X	Periodontics	9130	CO
2	1223P0300X	Periodontics	8560	NC

General Provider Information

NPI Number	:	1780834457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE R WRIGHT D.D.S.

Provider Business Mailing Address
First Line	:	3809 FORRESTGATE DR STE A
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2982
Country	:	US
Telephone Number	:	336-768-9010
Fax Number	:	336-768-9011

Provider Business Practice Location Address
First Line	:	3809 FORRESTGATE DR STE A
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2982
Country	:	US
Telephone Number	:	336-768-9010
Fax Number	:	336-768-9011

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

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	05/06/2024

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