Provider Demographics
NPI:1720285612
Name:VANDALIA DENTAL CENTER, WAYNE K. WRIGHT, DDS, INC.
Entity Type:Organization
Organization Name:VANDALIA DENTAL CENTER, WAYNE K. WRIGHT, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-898-4639
Mailing Address - Street 1:61 N DIXIE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2037
Mailing Address - Country:US
Mailing Address - Phone:937-898-4639
Mailing Address - Fax:937-898-3551
Practice Address - Street 1:61 N DIXIE DR
Practice Address - Street 2:SUITE A
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2037
Practice Address - Country:US
Practice Address - Phone:937-898-4639
Practice Address - Fax:937-898-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH125981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty