Provider Demographics
NPI:1609869544
Name:ALBRIGHT, MICHAEL DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:ALBRIGHT
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 1:121 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-2822
Mailing Address - Country:US
Mailing Address - Phone:913-651-5040
Mailing Address - Fax:913-651-5582
Practice Address - Street 1:121 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-2822
Practice Address - Country:US
Practice Address - Phone:913-651-5040
Practice Address - Fax:913-651-5582
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
792805OtherUNITED CONCORDIA
MO23384016OtherBLUE CROSS BLUE SHEILD
AL65014260OtherBLUE CROSS BLUE SHEILD
KS17389OtherBLUE CROSS BLUE SHEILD