Provider Demographics
NPI:1043370422
Name:WILCOX, ANDREW SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SCOTT
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 1:1201 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1226
Mailing Address - Country:US
Mailing Address - Phone:320-253-4242
Mailing Address - Fax:320-253-7778
Practice Address - Street 1:1201 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1226
Practice Address - Country:US
Practice Address - Phone:320-253-4242
Practice Address - Fax:320-253-7778
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122331223G0001X
MND-122331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN368274900Medicaid