Provider Demographics
NPI:1417112152
Name:VIX, DONNA MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIA
Last Name:VIX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 POTTERS ROAD
Mailing Address - Street 2:PO BOX 173
Mailing Address - City:STILL WATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07875
Mailing Address - Country:US
Mailing Address - Phone:973-579-3662
Mailing Address - Fax:973-579-2807
Practice Address - Street 1:935 POTTERS ROAD
Practice Address - Street 2:
Practice Address - City:STILL WATER
Practice Address - State:NJ
Practice Address - Zip Code:07875
Practice Address - Country:US
Practice Address - Phone:973-579-3662
Practice Address - Fax:973-579-2807
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1016113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist