Provider Demographics
NPI:1659755189
Name:VIJ, AKSHAY (BDS)
Entity Type:Individual
Prefix:DR
First Name:AKSHAY
Middle Name:
Last Name:VIJ
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 LINDELL BLVD APT 1014
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3736
Mailing Address - Country:US
Mailing Address - Phone:310-869-8152
Mailing Address - Fax:
Practice Address - Street 1:195 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DUPO
Practice Address - State:IL
Practice Address - Zip Code:62239-1347
Practice Address - Country:US
Practice Address - Phone:618-286-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105564122300000X
MO2020030635122300000X
WA60509168122300000X
IL019.030501122300000X
MO2015021494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist