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General NPI Number Information
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NPI Number | 1033694484
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Entity Type | Individual
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Provider Name | GARY JOE WRIGHT DDS
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Gender | Male
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 3401 WEBBERVILLE RD RM 8149
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City | AUSTIN
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State | TX
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Zip | 78702-3004
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Country | US
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Telephone | 512-223-5717
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Fax |
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Provider Business Mailing Address
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Address Line | 3105 MADISINA DR
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City | CEDAR PARK
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State | TX
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Zip | 78641-2639
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Country | US
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Telephone | 512-223-5717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13294
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License Number State | TX
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