Provider Demographics
NPI:1801125679
Name:CATHERINE G. WILCOX, DDS
Entity type:Organization
Organization Name:CATHERINE G. WILCOX, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GUY
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-963-7861
Mailing Address - Street 1:1125 MICHIGAN AVE E
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-6832
Mailing Address - Country:US
Mailing Address - Phone:269-963-7861
Mailing Address - Fax:269-963-0579
Practice Address - Street 1:1125 MICHIGAN AVE E
Practice Address - Street 2:SUITE 7
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-6832
Practice Address - Country:US
Practice Address - Phone:269-963-7861
Practice Address - Fax:269-963-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790738557Medicaid
MI1376677443Medicaid