Provider Demographics
NPI:1871721357
Name:WRIGHT, SAMUEL WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WILLIAM
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 1:136 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-9072
Mailing Address - Country:US
Mailing Address - Phone:479-437-3449
Mailing Address - Fax:479-437-3708
Practice Address - Street 1:136 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-9072
Practice Address - Country:US
Practice Address - Phone:479-437-3449
Practice Address - Fax:479-437-3708
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178407608Medicaid