Provider Demographics
NPI:1760462675
Name:ALBRIGHT, BRUCE W (DDS PA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:ALBRIGHT
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 30TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2475
Mailing Address - Country:US
Mailing Address - Phone:620-669-9911
Mailing Address - Fax:620-669-6838
Practice Address - Street 1:210 E 30TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2475
Practice Address - Country:US
Practice Address - Phone:620-669-9911
Practice Address - Fax:620-669-6838
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST44034Medicare UPIN
KS116745Medicare ID - Type Unspecified