MEDICARE: DR. DENISE NIXON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019027273	IL

General Provider Information

NPI Number	:	1467580316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE NIXON D.D.S.

Provider Business Mailing Address
First Line	:	2307 W. 95TH ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643
Country	:	US
Telephone Number	:	773-941-4403
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 W. 95TH ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643
Country	:	US
Telephone Number	:	773-941-4403
Fax Number	:	773-941-6474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	09/13/2013

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