Provider Demographics
NPI:1699920215
Name:WILLCOX, BRADLEY J (DMD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:WILLCOX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 W THUNDERBIRD RD STE B8-310
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4654
Mailing Address - Country:US
Mailing Address - Phone:623-521-9120
Mailing Address - Fax:
Practice Address - Street 1:6949 E SHEA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6146
Practice Address - Country:US
Practice Address - Phone:480-998-8073
Practice Address - Fax:480-867-6648
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD38861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice