Provider Demographics
NPI:1225360191
Name:PATRICK B. WILCOX D.D.S, PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:PATRICK B. WILCOX D.D.S, PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-686-8611
Mailing Address - Street 1:2501 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8463
Mailing Address - Country:US
Mailing Address - Phone:956-686-8611
Mailing Address - Fax:956-686-2668
Practice Address - Street 1:2501 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8463
Practice Address - Country:US
Practice Address - Phone:956-686-8611
Practice Address - Fax:956-686-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120793801Medicaid