Provider Demographics
NPI:1629303243
Name:WILCOX, NATALIE RANEE (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RANEE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PRESERVE AVE E
Mailing Address - Street 2:#8304
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1687
Mailing Address - Country:US
Mailing Address - Phone:402-440-3922
Mailing Address - Fax:
Practice Address - Street 1:MCRD
Practice Address - Street 2:
Practice Address - City:PARRIS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29905
Practice Address - Country:US
Practice Address - Phone:843-228-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist