Provider Demographics
NPI:1194929695
Name:WILLCOX, VINCENT RUSSELL (DDS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:RUSSELL
Last Name:WILLCOX
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:PO BOX 7326
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-7326
Mailing Address - Country:US
Mailing Address - Phone:405-341-8804
Mailing Address - Fax:405-341-4967
Practice Address - Street 1:950 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3024
Practice Address - Country:US
Practice Address - Phone:405-341-8804
Practice Address - Fax:405-341-4967
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice