Provider Demographics
NPI:1003022872
Name:VIXIE, GREGORY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:VIXIE
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 1:10900 WEATHERSTONE PL
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-7900
Mailing Address - Country:US
Mailing Address - Phone:530-613-5798
Mailing Address - Fax:530-274-8245
Practice Address - Street 1:707 ZION ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2932
Practice Address - Country:US
Practice Address - Phone:530-265-4206
Practice Address - Fax:530-265-9033
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist