Healthcare Provider Details

I. General information

NPI: 1326763558
Provider Name (Legal Business Name): ANNA JENNINGS NIX, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 HIGHWAY 80 W STE A
CLINTON MS
39056-4156
US

IV. Provider business mailing address

315 PENROSE PL
MADISON MS
39110-1200
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-4900
  • Fax:
Mailing address:
  • Phone: 662-299-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNA JENNINGS NIX
Title or Position: OWNER
Credential: DMD
Phone: 601-924-4900