Provider Demographics
NPI:1376755769
Name:JAMES R. WILLCOX, DMD, PC
Entity Type:Organization
Organization Name:JAMES R. WILLCOX, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-978-3000
Mailing Address - Street 1:13619 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1203
Mailing Address - Country:US
Mailing Address - Phone:602-978-3000
Mailing Address - Fax:602-468-2894
Practice Address - Street 1:13619 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1203
Practice Address - Country:US
Practice Address - Phone:602-978-3000
Practice Address - Fax:602-468-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty