Provider Demographics
NPI:1760766729
Name:WILCOX, DAVID J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:WILCOX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:J
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1920 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6624
Mailing Address - Country:US
Mailing Address - Phone:406-728-6068
Mailing Address - Fax:406-829-0868
Practice Address - Street 1:1920 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6624
Practice Address - Country:US
Practice Address - Phone:406-728-6068
Practice Address - Fax:406-829-0868
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61801223G0001X
MT48151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice