Provider Demographics
NPI:1053792705
Name:WRIGHT, AUSTIN TYLER (DDS)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:TYLER
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:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:BOLT
Mailing Address - State:WV
Mailing Address - Zip Code:25817-0439
Mailing Address - Country:US
Mailing Address - Phone:304-573-6767
Mailing Address - Fax:
Practice Address - Street 1:411 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2805
Practice Address - Country:US
Practice Address - Phone:304-252-4897
Practice Address - Fax:304-252-2892
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist