Provider Demographics
NPI:1639275217
Name:NIX, NED LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:NED
Middle Name:LEONARD
Last Name:NIX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:704 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5403
Mailing Address - Country:US
Mailing Address - Phone:408-225-5000
Mailing Address - Fax:408-225-5020
Practice Address - Street 1:704 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-5403
Practice Address - Country:US
Practice Address - Phone:408-225-5000
Practice Address - Fax:408-225-5020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA430541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery