Healthcare Provider Details

I. General information

NPI: 1730238197
Provider Name (Legal Business Name): MARVIN DEAN WRIGHT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N WEBB RD BLDG 301
WICHITA KS
67206
US

IV. Provider business mailing address

2020 N WEBB RD BLDG 301
WICHITA KS
67206
US

V. Phone/Fax

Practice location:
  • Phone: 316-687-2110
  • Fax: 316-636-9539
Mailing address:
  • Phone: 316-687-2110
  • Fax: 316-636-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5290
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: