Provider Demographics
NPI:1760476873
Name:WILLCOX, VERNON RALPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:RALPH
Last Name:WILLCOX
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:PO BOX 7326
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-7326
Mailing Address - Country:US
Mailing Address - Phone:405-341-8804
Mailing Address - Fax:
Practice Address - Street 1:950 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3024
Practice Address - Country:US
Practice Address - Phone:405-341-8804
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice