Provider Demographics
NPI:1871999532
Name:WRIGHT, GEORGE RANDALL (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RANDALL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 W FABYAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1572
Mailing Address - Country:US
Mailing Address - Phone:630-208-1200
Mailing Address - Fax:630-402-0378
Practice Address - Street 1:2550 W FABYAN PKWY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1572
Practice Address - Country:US
Practice Address - Phone:630-208-1200
Practice Address - Fax:630-402-0378
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024145122300000X
IL0210020221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist