Provider Demographics
NPI:1841308145
Name:WILCOX, JAMES MICHAEL (DR)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:WILCOX
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 STONE GATE DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-9339
Mailing Address - Country:US
Mailing Address - Phone:304-242-4682
Mailing Address - Fax:304-242-8950
Practice Address - Street 1:1 LUMBER AVENUE EXT
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5389
Practice Address - Country:US
Practice Address - Phone:304-242-8959
Practice Address - Fax:304-242-8950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist