Provider Demographics
NPI:1073849808
Name:WILCOX, MICHAEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
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:P.O. BOX 944
Mailing Address - Street 2:COLOMA DENTAL OFFICE
Mailing Address - City:LOTUS
Mailing Address - State:CA
Mailing Address - Zip Code:95651-0944
Mailing Address - Country:US
Mailing Address - Phone:530-621-0900
Mailing Address - Fax:530-621-0903
Practice Address - Street 1:7170 HWY 49
Practice Address - Street 2:
Practice Address - City:LOTUS
Practice Address - State:CA
Practice Address - Zip Code:95651-0944
Practice Address - Country:US
Practice Address - Phone:530-621-0900
Practice Address - Fax:530-621-0903
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist