MEDICARE: KINGSLEY ROAD DENTAL CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1164685418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSLEY ROAD DENTAL CENTER PC

Provider Business Mailing Address
First Line	:	1606 WEST KINGSLEY ROAD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-4218
Country	:	US
Telephone Number	:	972-271-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 WEST KINGSLEY ROAD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-4218
Country	:	US
Telephone Number	:	972-271-7111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL EARL NIXON
Credential	:	DDS
Telephone Number	:	972-271-7111

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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