Provider Demographics
NPI:1831185115
Name:WRIGHT, KIMBERLY R (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:R
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3241
Mailing Address - Country:US
Mailing Address - Phone:503-655-9300
Mailing Address - Fax:503-655-9305
Practice Address - Street 1:1554 GARDEN ST
Practice Address - Street 2:STE 104
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3278
Practice Address - Country:US
Practice Address - Phone:503-655-9300
Practice Address - Fax:503-655-9305
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD66101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice