MEDICARE: DR. MARC S WRIGHT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN 012817	GA

General Provider Information

NPI Number	:	1861712002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC S WRIGHT D.D.S.

Provider Business Mailing Address
First Line	:	3019-B NORTH DRUID HILLS ROAD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3924
Country	:	US
Telephone Number	:	404-417-0771
Fax Number	:	404-417-0772

Provider Business Practice Location Address
First Line	:	3019 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3911
Country	:	US
Telephone Number	:	404-417-0771
Fax Number	:	404-417-0772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	02/22/2011

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