Provider Demographics
NPI:1750440632
Name:WRIGHT, RICHARD (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
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 1:126 N 30TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3719
Mailing Address - Country:US
Mailing Address - Phone:217-228-3384
Mailing Address - Fax:217-228-3202
Practice Address - Street 1:126 N 30TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3719
Practice Address - Country:US
Practice Address - Phone:217-228-3384
Practice Address - Fax:217-228-3202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice