Provider Demographics
NPI:1285878975
Name:WRIGHT, MARK DENTON (CST/CFA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DENTON
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8744 CREEDE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7813
Mailing Address - Country:US
Mailing Address - Phone:281-782-0020
Mailing Address - Fax:
Practice Address - Street 1:8744 CREEDE TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-7813
Practice Address - Country:US
Practice Address - Phone:281-782-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103965246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist