Provider Demographics
NPI:1710905641
Name:DONALD V. NIX D.D.S., P.A.
Entity Type:Organization
Organization Name:DONALD V. NIX D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-985-7555
Mailing Address - Street 1:2 WIMBLEDON CT
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5939
Mailing Address - Country:US
Mailing Address - Phone:972-985-7555
Mailing Address - Fax:972-964-5193
Practice Address - Street 1:5501 INDEPENDENCE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5469
Practice Address - Country:US
Practice Address - Phone:972-985-7555
Practice Address - Fax:972-964-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126071223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113900OtherCIGNA DMO
TX113900OtherCIGNA DMO
TX=========Medicare UPIN