Provider Demographics
NPI:1114922382
Name:WILCOX, RONALD CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CARL
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 1:1235 ROBINSON RD
Mailing Address - Street 2:STE H
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3832
Mailing Address - Country:US
Mailing Address - Phone:770-487-1880
Mailing Address - Fax:770-487-1851
Practice Address - Street 1:1235 ROBINSON RD
Practice Address - Street 2:STE H
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3832
Practice Address - Country:US
Practice Address - Phone:770-487-1880
Practice Address - Fax:770-487-1851
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0099891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice