Provider Demographics
NPI:1144994351
Name:WRIGHT, BRADY NICHOLAS (DO)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:NICHOLAS
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:PA
Mailing Address - Zip Code:15962-0041
Mailing Address - Country:US
Mailing Address - Phone:814-244-0329
Mailing Address - Fax:
Practice Address - Street 1:1390 EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3216
Practice Address - Country:US
Practice Address - Phone:814-535-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0433011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice