Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | DN 11755 | FL |
Y | 1223P0300X | Periodontist | DN 11755 | FL |
NPI | 1487668430 |
---|---|
Provider Name | Dr. Kenneth Ronald Wright |
First Address | Leesburg, VA 20176-3650 |
Second Address | Leesburg, VA 20176-3650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 27/07/2010 |