Provider Demographics
NPI:1760522148
Name:NIX, RALPH MARION (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MARION
Last Name:NIX
Suffix:
Gender:M
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-0655
Mailing Address - Country:US
Mailing Address - Phone:256-356-8641
Mailing Address - Fax:256-356-8644
Practice Address - Street 1:513 W 3RD ST
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582
Practice Address - Country:US
Practice Address - Phone:256-356-8641
Practice Address - Fax:256-356-8644
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice