Individual provider Active NPI

John M Wright, DDS

  • Oral and Maxillofacial Pathology Dentistry
  • Dallas, TX
National Provider Identifier
1104964295
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
License
13162 Issued in TX
Practice address
3302 Gaston Ave
Dallas, TX 75246-2013
Phone
(214) 828-8118
Fax
(214) 828-8306
NPI assigned
Feb 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 13162 TX
Oral and Maxillofacial Pathology Dentistry 1223P0106X 13162 TX Primary

Addresses

Primary practice location

3302 Gaston Ave
Dallas, TX 75246-2013

Mailing address

3302 Gaston Ave
Dallas, TX 75246-2013
Phone (214) 828-8118

Other identifiers 1

IdentifierTypeStateIssuer
090093802MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120314000220 TX Practitioner - Oral and Maxillofacial PathologyPractitioner - Oral Surgery 1951384916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral and Maxillofacial Pathology
Education
West Virginia University School of Dentistry, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Aandm University System Health Science CenterGroup PAC ID 3173931292, 9 clinicians

Practice addresses (Care Compare)

3302 Gaston Ave
Dallas, TX 75246-2013
Phone (214) 828-8479

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13162TXMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Texas a&M University System Health Science Center CurrentSince Jan 14, 2024 Accepting new patients
Oral Surgery Associates of North Texas, PC PastSince May 25, 2017 Accepting new patients

Locations

3302 Gaston Ave
Dallas, TX 75246
Phone (214) 828-8100

3000 Gaston Ave
Dallas, TX 75226
Phone (214) 828-8100

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1104964295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3302 GASTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462013",
            "telephone_number": "214-828-8118",
            "fax_number": "214-828-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3302 GASTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462013",
            "telephone_number": "214-828-8118",
            "fax_number": "214-828-8306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "13162",
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "TX",
            "license": "13162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090093802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.