Provider Demographics
NPI:1679702070
Name:BRUCE V. WAINRIGHT DDS MAGD PA
Entity type:Organization
Organization Name:BRUCE V. WAINRIGHT DDS MAGD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-847-1322
Mailing Address - Street 1:6837 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5308
Mailing Address - Country:US
Mailing Address - Phone:919-847-1322
Mailing Address - Fax:919-847-4016
Practice Address - Street 1:6837 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5308
Practice Address - Country:US
Practice Address - Phone:919-847-1322
Practice Address - Fax:919-847-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3731122300000X
NC8061122300000X
NC8040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC98813Medicaid
NC5902963Medicaid
NC5902964Medicaid