Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 37303 | CA |
NPI | 1003022872 |
---|---|
Provider Name | Dr. Gregory E Vixie |
First Address | Grass Valley, CA 95949-7900 |
Second Address | Nevada City, CA 95959-2932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 07/04/2020 |