Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 20168 | OH |
NPI | 1154466761 |
---|---|
Provider Name | Dr. Vinson Vig |
First Address | Broadview Heights, OH 44147-1200 |
Second Address | Broadview Heights, OH 44147-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |