Provider Demographics
NPI:1710204920
Name:WILCOX, GARY HOWARD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:HOWARD
Last Name:WILCOX
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 MIAMI AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2676
Mailing Address - Country:US
Mailing Address - Phone:513-271-5900
Mailing Address - Fax:
Practice Address - Street 1:7140 MIAMI AVE STE 202
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2676
Practice Address - Country:US
Practice Address - Phone:513-271-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0242371223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program