Provider Demographics
NPI:1548504855
Name:JEREL WRIGHT DDS
Entity type:Organization
Organization Name:JEREL WRIGHT DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-264-1846
Mailing Address - Street 1:715 E 3900 S
Mailing Address - Street 2:103
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2182
Mailing Address - Country:US
Mailing Address - Phone:801-266-4701
Mailing Address - Fax:801-269-0627
Practice Address - Street 1:715 E 3900 S
Practice Address - Street 2:103
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2182
Practice Address - Country:US
Practice Address - Phone:801-266-4701
Practice Address - Fax:801-269-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty