Healthcare Provider Details

I. General information

NPI: 1538224522
Provider Name (Legal Business Name): DALE T NIXON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LAKE SHORE DR W
ASHLAND WI
54806-1507
US

IV. Provider business mailing address

PO BOX 41
MANITOWISH WATERS WI
54545-0041
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-2811
  • Fax:
Mailing address:
  • Phone: 715-543-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3829 015 EWI
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: