Provider Demographics
NPI:1588643845
Name:WRIGHT, MARCUS L A (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:L A
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 1:217 S 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-0364
Mailing Address - Country:US
Mailing Address - Phone:708-681-9400
Mailing Address - Fax:708-681-9493
Practice Address - Street 1:217 S 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-0364
Practice Address - Country:US
Practice Address - Phone:708-681-9400
Practice Address - Fax:708-681-9493
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20190225601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019022560Medicaid