Provider Demographics
NPI:1093863276
Name:WRIGHT, MARVIN GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:GENE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1640
Mailing Address - Country:US
Mailing Address - Phone:260-563-7322
Mailing Address - Fax:260-563-8653
Practice Address - Street 1:948 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1640
Practice Address - Country:US
Practice Address - Phone:260-563-7322
Practice Address - Fax:260-563-8653
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN63411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice