Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS040889 | PA |
NPI | 1689346090 |
---|---|
Provider Name | Dr. Gary Lee Wright |
First Address | Portsmouth, VA 23703-2135 |
Second Address | Portsmouth, VA 23703-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2021 |
Last Update Date | 04/10/2021 |