Provider Demographics
NPI:1487668430
Name:WRIGHT, KENNETH RONALD (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RONALD
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 FOUNTAIN HALL CT NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3650
Mailing Address - Country:US
Mailing Address - Phone:703-669-1964
Mailing Address - Fax:703-669-1964
Practice Address - Street 1:810 FOUNTAIN HALL CT NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3650
Practice Address - Country:US
Practice Address - Phone:703-669-1964
Practice Address - Fax:703-669-1964
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 117551223P0300X
FLDN 117551223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223D0001XDental ProvidersDentistDental Public Health