Provider Demographics
NPI:1184846545
Name:ALAN M WIXOM DDS PC
Entity Type:Organization
Organization Name:ALAN M WIXOM DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIXOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-242-9202
Mailing Address - Street 1:2490 PATTERSON RD.
Mailing Address - Street 2:UNIT 2
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-242-9202
Mailing Address - Fax:
Practice Address - Street 1:2490 PATTERSON RD.
Practice Address - Street 2:UNIT 2
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-242-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6381261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental