Provider Demographics
NPI:1265527840
Name:WRIGHT, MICHAEL MCBREARTY (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MCBREARTY
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1502 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8423
Mailing Address - Country:US
Mailing Address - Phone:478-742-1218
Mailing Address - Fax:478-755-9679
Practice Address - Street 1:1502 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8423
Practice Address - Country:US
Practice Address - Phone:478-742-1218
Practice Address - Fax:478-755-9679
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058033204E00000X
GADN0117691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery