Provider Demographics
NPI:1073235339
Name:CATHERINE G. WILCOX DDS LLC
Entity Type:Organization
Organization Name:CATHERINE G. WILCOX DDS LLC
Other - Org Name:CATHERINE G. WILCOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-986-0549
Mailing Address - Street 1:395 S SHORE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5466
Mailing Address - Country:US
Mailing Address - Phone:269-963-7861
Mailing Address - Fax:
Practice Address - Street 1:395 S SHORE DR STE 102
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5466
Practice Address - Country:US
Practice Address - Phone:269-963-7861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901017210OtherDENTAL LICENSE