Provider Demographics
NPI:1497888234
Name:WILCOX, JEAN-CLAUDE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN-CLAUDE
Middle Name:E
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 1:7111 PROSPECT PL NE
Mailing Address - Street 2:SUITE D201
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4309
Mailing Address - Country:US
Mailing Address - Phone:505-268-4484
Mailing Address - Fax:505-268-3243
Practice Address - Street 1:7111 PROSPECT PL NE
Practice Address - Street 2:SUITE D201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4309
Practice Address - Country:US
Practice Address - Phone:505-268-4484
Practice Address - Fax:505-268-3243
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM16761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice