Provider Demographics
NPI:1730197690
Name:WRIGHT, SCOTT ALAN (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12249 W MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2471
Mailing Address - Country:US
Mailing Address - Phone:208-322-0024
Mailing Address - Fax:208-375-5721
Practice Address - Street 1:12249 W MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2471
Practice Address - Country:US
Practice Address - Phone:208-322-0024
Practice Address - Fax:208-375-5721
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD20681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice