Provider Demographics
NPI:1003070715
Name:WRIGHT, JUSTIN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
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 1:1465 W 2ND AVE
Mailing Address - Street 2:STE 125
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3792
Mailing Address - Country:US
Mailing Address - Phone:903-872-8422
Mailing Address - Fax:
Practice Address - Street 1:1465 W 2ND AVE
Practice Address - Street 2:STE 125
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3792
Practice Address - Country:US
Practice Address - Phone:903-872-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist