Provider Demographics
NPI:1700926599
Name:WILCOX, DONALD L (DDS PC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:WILCOX
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18275 N 59TH AVE STE 114 BLDG C
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1252
Mailing Address - Country:US
Mailing Address - Phone:602-978-1790
Mailing Address - Fax:602-978-5211
Practice Address - Street 1:18275 N 59TH AVE STE 114 BLDG C
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1252
Practice Address - Country:US
Practice Address - Phone:602-978-1790
Practice Address - Fax:602-978-5211
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice