Provider Demographics
NPI:1972528628
Name:WILCOX, SCOTT ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROBERT
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 1:1139 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1230
Mailing Address - Country:US
Mailing Address - Phone:320-253-4242
Mailing Address - Fax:320-253-7778
Practice Address - Street 1:1139 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1230
Practice Address - Country:US
Practice Address - Phone:320-253-4242
Practice Address - Fax:320-253-7778
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN07720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist