Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 24066 | TX |
NPI | 1003070715 |
---|---|
Provider Name | Dr. Justin C Wright |
First Address | Corsicana, TX 75110-3792 |
Second Address | Corsicana, TX 75110-3792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 17/02/2012 |