Provider Demographics
NPI:1194960062
Name:WRIGHT, JAMES WALTER (DMD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WALTER
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:SECTION
Mailing Address - State:AL
Mailing Address - Zip Code:35771
Mailing Address - Country:US
Mailing Address - Phone:256-228-6233
Mailing Address - Fax:256-228-6233
Practice Address - Street 1:289 MAIN ST SOUTH
Practice Address - Street 2:
Practice Address - City:SECTION
Practice Address - State:AL
Practice Address - Zip Code:35771
Practice Address - Country:US
Practice Address - Phone:256-228-6233
Practice Address - Fax:256-228-6233
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
97689OtherBC/BS