Provider Demographics
NPI:1821109919
Name:ALICIA MIZE RIX, DMD PC
Entity Type:Organization
Organization Name:ALICIA MIZE RIX, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MIZE
Authorized Official - Last Name:RIX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-235-4723
Mailing Address - Street 1:57 THREE RIVERS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4998
Mailing Address - Country:US
Mailing Address - Phone:706-235-4723
Mailing Address - Fax:706-295-2552
Practice Address - Street 1:57 THREE RIVERS DR NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-4998
Practice Address - Country:US
Practice Address - Phone:706-235-4723
Practice Address - Fax:706-295-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0110531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA011053OtherDENTAL LICENSE #