Provider Demographics
NPI:1972516250
Name:WRIGHT, MACK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MACK
Middle Name:
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 1:1028 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9007
Mailing Address - Country:US
Mailing Address - Phone:937-652-4111
Mailing Address - Fax:937-652-0166
Practice Address - Street 1:1028 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9007
Practice Address - Country:US
Practice Address - Phone:937-652-4111
Practice Address - Fax:937-652-0166
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH203021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice