Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN1857241 | MA |
NPI | 1134569247 |
---|---|
Provider Name | Dr. Roberta Anne Wright |
First Address | Malden, MA 02148-7786 |
Second Address | Malden, MA 02148-7786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 18/07/2016 |