Provider Demographics
NPI:1366479164
Name:WILCOX, WILLIAM GARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GARY
Last Name:WILCOX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4126
Mailing Address - Country:US
Mailing Address - Phone:860-633-6576
Mailing Address - Fax:860-659-3594
Practice Address - Street 1:1005 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2127
Practice Address - Country:US
Practice Address - Phone:860-232-7270
Practice Address - Fax:860-236-3032
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist