Provider Demographics
NPI:1437817566
Name:WRIGHT, JESSICA (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LILAC CT
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1848
Mailing Address - Country:US
Mailing Address - Phone:860-817-6092
Mailing Address - Fax:
Practice Address - Street 1:500 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2508
Practice Address - Country:US
Practice Address - Phone:860-249-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007538124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT047853832Medicaid