Provider Demographics
NPI:1639494131
Name:WRIGLEY, MARK
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WRIGLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 CANTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9465
Mailing Address - Country:US
Mailing Address - Phone:724-799-7070
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE STREET
Practice Address - Street 2:
Practice Address - City:PGH
Practice Address - State:PA
Practice Address - Zip Code:15261
Practice Address - Country:US
Practice Address - Phone:412-648-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027054L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist