Provider Demographics
NPI:1962511105
Name:FOX, VIKI MAE (RDA)
Entity Type:Individual
Prefix:MISS
First Name:VIKI
Middle Name:MAE
Last Name:FOX
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 GIBRALTAR DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4636
Mailing Address - Country:US
Mailing Address - Phone:510-794-6591
Mailing Address - Fax:
Practice Address - Street 1:4465 GIBRALTAR DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4636
Practice Address - Country:US
Practice Address - Phone:510-794-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50964126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant