Provider Demographics
NPI:1790770220
Name:WRIGHT, BENNY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENNY
Middle Name:A
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 1:408 MARTIN LUTHER KING JR. STREET
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3363
Mailing Address - Country:US
Mailing Address - Phone:601-446-5971
Mailing Address - Fax:601-442-8879
Practice Address - Street 1:408 N MARTIN LUTHER KING JR ST
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3363
Practice Address - Country:US
Practice Address - Phone:601-446-5971
Practice Address - Fax:601-442-8879
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1496-721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00063087Medicaid