Provider Demographics
NPI:1043541907
Name:WIGHT, JEFFREY CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CRAIG
Last Name:WIGHT
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 1:4135 S POWER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3625
Mailing Address - Country:US
Mailing Address - Phone:480-588-2188
Mailing Address - Fax:602-992-6604
Practice Address - Street 1:4135 S POWER RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3625
Practice Address - Country:US
Practice Address - Phone:480-588-2188
Practice Address - Fax:480-588-2116
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7838122300000X
AZD078381223S0112X, 332B00000X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies