Provider Demographics
NPI:1295386738
Name:SMILE WRIGHT XENIA LLC
Entity Type:Organization
Organization Name:SMILE WRIGHT XENIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:N
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-322-5437
Mailing Address - Street 1:1627 SELMA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-4245
Mailing Address - Country:US
Mailing Address - Phone:937-322-5437
Mailing Address - Fax:
Practice Address - Street 1:20 KING AVE
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2214
Practice Address - Country:US
Practice Address - Phone:937-322-5437
Practice Address - Fax:937-322-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1356399794OtherNPI
OH2488188Medicaid