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General NPI Number Information
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NPI Number | 1407838113
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Entity Type | Organization
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Legal Business Name | EDMOND DENTAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 950 MEDICAL PARK BLVD
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City | EDMOND
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State | OK
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Zip | 73013-3024
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Country | US
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Telephone | 405-341-8804
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Fax | 405-341-4967
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Provider Business Mailing Address
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Address Line | PO BOX 7326
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City | EDMOND
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State | OK
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Zip | 73083-7326
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Country | US
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Telephone | 405-341-8804
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Fax | 405-341-4967
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | DR. V. RALPH WILLCOX
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Credential | DDS
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Telephone | 405-341-8804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4715 AND 5969
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License Number State | OK
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