Provider Demographics
NPI:1477843613
Name:DONALD L. WILCOX D.D.S. P.C.
Entity Type:Organization
Organization Name:DONALD L. WILCOX D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:602-978-1790
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:SUITE 114, BUILDING C
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-978-1790
Mailing Address - Fax:602-978-5211
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:SUITE 114, BUILDING C
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-978-1790
Practice Address - Fax:602-978-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6501180001Medicare NSC