Provider Demographics
NPI:1063676526
Name:WILCOX, JEFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:WILCOX
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 1:1345 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1304
Mailing Address - Country:US
Mailing Address - Phone:614-475-2051
Mailing Address - Fax:614-235-6326
Practice Address - Street 1:1345 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1304
Practice Address - Country:US
Practice Address - Phone:614-475-2051
Practice Address - Fax:614-235-6326
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist