Individual
WAYNE JACK WRIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2200 PARK AVE, BURLEY, ID 83318-2186
(208) 678-1478
Mailing address
2755 FAIRMONT DR, BURLEY, ID 83318-2841
(208) 677-2478
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3244
ID
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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