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General NPI Number Information
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NPI Number | 1821109919
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Entity Type | Organization
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Legal Business Name | ALICIA MIZE RIX, DMD PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 57 THREE RIVERS DR NE
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City | ROME
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State | GA
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Zip | 30161-4998
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Country | US
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Telephone | 706-235-4723
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Fax | 706-295-2552
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Provider Business Mailing Address
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Address Line | 57 THREE RIVERS DR NE
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City | ROME
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State | GA
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Zip | 30161-4998
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Country | US
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Telephone | 706-235-4723
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Fax | 706-295-2552
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALICIA MIZE RIX
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Credential | DMD
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Telephone | 706-235-4723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 011053
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License Number State | GA
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