Healthcare Provider Details

I. General information

NPI: 1790770220
Provider Name (Legal Business Name): BENNY A WRIGHT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N MARTIN LUTHER KING JR ST
NATCHEZ MS
39120-3363
US

IV. Provider business mailing address

408 MARTIN LUTHER KING JR. STREET
NATCHEZ MS
39120-3363
US

V. Phone/Fax

Practice location:
  • Phone: 601-446-5971
  • Fax: 601-442-8879
Mailing address:
  • Phone: 601-446-5971
  • Fax: 601-442-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1496-72
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: