Healthcare Provider Details

I. General information

NPI: 1003022872
Provider Name (Legal Business Name): GREGORY E VIXIE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 ZION ST SUITE C
NEVADA CITY CA
95959-2932
US

IV. Provider business mailing address

10900 WEATHERSTONE PL
GRASS VALLEY CA
95949-7900
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-4206
  • Fax: 530-265-9033
Mailing address:
  • Phone: 530-613-5798
  • Fax: 530-274-8245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: