Provider Demographics
NPI:1043228398
Name:WRIGHT, BRADLEY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
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 1:2301 N. WALDRON
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1133
Mailing Address - Country:US
Mailing Address - Phone:620-663-1141
Mailing Address - Fax:620-663-1373
Practice Address - Street 1:2301 N. WALDRON
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1133
Practice Address - Country:US
Practice Address - Phone:620-663-1141
Practice Address - Fax:620-663-1373
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01901922331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
L08509Medicare PIN
L08507Medicare PIN
K20893Medicare PIN
K20894Medicare PIN