Healthcare Provider Details

I. General information

NPI: 1346139318
Provider Name (Legal Business Name): LAKE WEDOWEE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 MAIN ST N
WEDOWEE AL
36278-7199
US

IV. Provider business mailing address

PO BOX 268
WEDOWEE AL
36278-0268
US

V. Phone/Fax

Practice location:
  • Phone: 256-357-2882
  • Fax:
Mailing address:
  • Phone: 256-357-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ALAN NIX
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 256-357-2882