Provider Demographics
NPI:1982754537
Name:WRIGHT, TIMOTHY MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1403 J R MILLER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3173
Mailing Address - Country:US
Mailing Address - Phone:270-684-3310
Mailing Address - Fax:270-684-0417
Practice Address - Street 1:1115 TAMARACK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6984
Practice Address - Country:US
Practice Address - Phone:270-684-3310
Practice Address - Fax:270-684-0417
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice