Provider Demographics
NPI:1770633281
Name:NIX, ALAN LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LAWRENCE
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 1:101 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2644
Mailing Address - Country:US
Mailing Address - Phone:972-563-7633
Mailing Address - Fax:972-551-0840
Practice Address - Street 1:101 E HIGH ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2644
Practice Address - Country:US
Practice Address - Phone:972-563-7633
Practice Address - Fax:972-551-0840
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198096301Medicaid