Provider Demographics
NPI:1932255288
Name:DONALD B. WILCOXON D.D.S, M.S., PA
Entity Type:Organization
Organization Name:DONALD B. WILCOXON D.D.S, M.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:913-661-9901
Mailing Address - Street 1:4601 W 109TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1318
Mailing Address - Country:US
Mailing Address - Phone:913-661-9901
Mailing Address - Fax:913-661-9702
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1318
Practice Address - Country:US
Practice Address - Phone:913-661-9901
Practice Address - Fax:913-661-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6068OtherSTATE LICENSE
MO13166OtherSTATE LICENSE
=========OtherEIN