Provider Demographics
NPI:1881186716
Name:WRIGHT, NIKI DENISE (DDS)
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:DENISE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22244 HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-4526
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
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180177281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice