Provider Demographics
NPI:1497824312
Name:NIX, MALINDA BYRD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:BYRD
Last Name:NIX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-2202
Mailing Address - Country:US
Mailing Address - Phone:334-297-3399
Mailing Address - Fax:334-297-3957
Practice Address - Street 1:3900 13TH AVE
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2202
Practice Address - Country:US
Practice Address - Phone:334-297-3399
Practice Address - Fax:334-297-3957
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice