Provider Demographics
NPI:1912136482
Name:WILCOX, BRANDON RODNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:RODNEY
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 1:2412 PATTERSON RD STE 7
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1259
Mailing Address - Country:US
Mailing Address - Phone:702-432-0259
Mailing Address - Fax:
Practice Address - Street 1:2412 PATTERSON RD STE 7
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1259
Practice Address - Country:US
Practice Address - Phone:702-432-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO202497122300000X
NE6926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist