Healthcare Provider Details

I. General information

NPI: 1699868372
Provider Name (Legal Business Name): BRUCE W ALBRIGHT DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 EAST 30TH AVE SUITE 110
HUTCHINSON KS
67502
US

IV. Provider business mailing address

210 EAST 30TH AVE SUITE 110
HUTCHINSON KS
67502
US

V. Phone/Fax

Practice location:
  • Phone: 620-669-9911
  • Fax: 620-669-6838
Mailing address:
  • Phone: 620-669-9911
  • Fax: 620-669-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4651
License Number StateKS

VIII. Authorized Official

Name: DR. BRUCE W ALBRIGHT
Title or Position: PRESIDENT
Credential: DDS
Phone: 620-669-9911