MEDICARE: DR. BRANDON RODNEY WILCOX D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	202497	CO

General Provider Information

NPI Number	:	1912136482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON RODNEY WILCOX D.D.S

Provider Business Mailing Address
First Line	:	2412 PATTERSON RD STE 7
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1259
Country	:	US
Telephone Number	:	702-432-0259
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 PATTERSON RD STE 7
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1259
Country	:	US
Telephone Number	:	702-432-0259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	08/25/2020

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