Healthcare Provider Details

I. General information

NPI: 1780798454
Provider Name (Legal Business Name): MICHAEL LEON WRIGHT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CRESTWOOD RD STE 301
NORTH LITTLE ROCK AR
72116-7617
US

IV. Provider business mailing address

2501 CRESTWOOD RD STE 301
NORTH LITTLE ROCK AR
72116-7617
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-1565
  • Fax: 501-758-1842
Mailing address:
  • Phone: 501-758-1565
  • Fax: 501-758-1842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2620
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: