Provider Demographics
NPI:1477954980
Name:KELLY A WRIGHT DMD AND ASSOCIATES PA
Entity Type:Organization
Organization Name:KELLY A WRIGHT DMD AND ASSOCIATES PA
Other - Org Name:BENSON FAMILY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR/V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-568-8292
Mailing Address - Street 1:303 S WALTON DR
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-9396
Mailing Address - Country:US
Mailing Address - Phone:919-894-1612
Mailing Address - Fax:919-894-2556
Practice Address - Street 1:303 S WALTON DR
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-9396
Practice Address - Country:US
Practice Address - Phone:919-894-1612
Practice Address - Fax:919-894-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902ERMedicaid