=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538128426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ARTHUR WILCOX DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9045 VIA AMORITA
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-2749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-923-5920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MED CO. 1SB UNIT 31530
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AE
-----------------------------------------------------
Zip | 09833
-----------------------------------------------------
Country | EG
-----------------------------------------------------
Telephone | 11-972-8628
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE00010095
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------