Provider Demographics
NPI:1437129467
Name:WILCOX, JAY ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALAN
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 1:8500 42ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1184
Mailing Address - Country:US
Mailing Address - Phone:763-537-6070
Mailing Address - Fax:763-537-6076
Practice Address - Street 1:8500 42ND AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1184
Practice Address - Country:US
Practice Address - Phone:763-537-6070
Practice Address - Fax:763-537-6076
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist