Individual provider Active NPI

Raquel Pacheco Wright, DMD

  • Dentist
  • Dallas, TX
National Provider Identifier
1700082419
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
23761 Issued in TX
Practice address
3910 Gaston Ave Ste 175
Dallas, TX 75246-1504
Phone
(214) 257-1082
Fax
(214) 823-2326
NPI assigned
Jun 21, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 23761 TX Primary

Addresses

Primary practice location

3910 Gaston Ave Ste 175
Dallas, TX 75246-1504

Mailing address

PO Box 1168
Anniston, AL 36202-1168
Phone (256) 241-7340

Other practice location 1

2530 S Buckner Blvd
Dallas, TX 75227-8548
Phone (972) 616-0060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170426002524 TX Order and Referring Only - DentistPractitioner - Dentist 2264719343

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23761TXMDPsychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1700082419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1168",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362021168",
            "telephone_number": "256-241-7340",
            "fax_number": "256-241-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 GASTON AVE STE 175",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461504",
            "telephone_number": "214-257-1082",
            "fax_number": "214-823-2326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2530 S Buckner Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752278548",
            "country_code": "US",
            "telephone_number": "972-616-0060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "RAQUEL",
        "middle_name": "PACHECO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-21",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "23761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.