Provider Demographics
NPI:1417434739
Name:NIXON, GIANINA CORREA (DDS)
Entity Type:Individual
Prefix:
First Name:GIANINA
Middle Name:CORREA
Last Name:NIXON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 POLLYDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-2315
Mailing Address - Country:US
Mailing Address - Phone:210-760-2975
Mailing Address - Fax:
Practice Address - Street 1:2539 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4643
Practice Address - Country:US
Practice Address - Phone:903-331-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice