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Individual

MS. LISA R WILCOX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS MS

Contact information

Practice address
3900 RIVER RIDGE DRIVE NE, CEDAR RAPIDS, IA 52402-7599
(319) 393-6335
(319) 294-8830
Mailing address
3900 RIVER RIDGE DRIVE NE, CEDAR RAPIDS, IA 52402-7599
(319) 393-6335

Taxonomy

Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
6989
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
58090
DELTA DENTAL
Enumeration date
02/01/2007
Last updated
07/08/2007
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