Provider Demographics
NPI:1578670717
Name:HIXSON DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:HIXSON DENTAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MULLINAX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-843-0418
Mailing Address - Street 1:6012A HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3032
Mailing Address - Country:US
Mailing Address - Phone:423-843-0418
Mailing Address - Fax:423-842-7362
Practice Address - Street 1:6012A HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3032
Practice Address - Country:US
Practice Address - Phone:423-843-0418
Practice Address - Fax:423-842-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty