Provider Demographics
NPI:1952586471
Name:WILCOX, RICHARD WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
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 1:5306 CORTEZ RD W
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2821
Mailing Address - Country:US
Mailing Address - Phone:941-792-1440
Mailing Address - Fax:941-798-3569
Practice Address - Street 1:5306 CORTEZ RD W
Practice Address - Street 2:SUITE #1
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2821
Practice Address - Country:US
Practice Address - Phone:941-792-1440
Practice Address - Fax:941-798-3569
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412008122300000X
FLDN17893122300000X
NC150590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist