Provider Demographics
NPI:1184195042
Name:WRIGHT DENTAL LLC
Entity Type:Organization
Organization Name:WRIGHT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-631-3397
Mailing Address - Street 1:263 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2134
Mailing Address - Country:US
Mailing Address - Phone:660-631-3397
Mailing Address - Fax:
Practice Address - Street 1:263 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-2134
Practice Address - Country:US
Practice Address - Phone:660-886-6843
Practice Address - Fax:660-886-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental