Healthcare Provider Details

I. General information

NPI: 1063412849
Provider Name (Legal Business Name): DONALD V NIX D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 INDEPENDENCE PKWY #104
PLANO TX
75023
US

IV. Provider business mailing address

5501 INDEPENDENCE PKWY STE 104
PLANO TX
75023-5469
US

V. Phone/Fax

Practice location:
  • Phone: 972-985-7555
  • Fax: 972-964-5193
Mailing address:
  • Phone: 972-985-7555
  • Fax: 972-964-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12607
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: