Provider Demographics
NPI:1952490633
Name:NIX, DANIEL ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALAN
Last Name:NIX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 BENTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173
Mailing Address - Country:US
Mailing Address - Phone:205-655-5144
Mailing Address - Fax:205-655-2566
Practice Address - Street 1:5750 BENTLEY WAY
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173
Practice Address - Country:US
Practice Address - Phone:205-655-5144
Practice Address - Fax:205-655-2566
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL667077OtherUNITED CONCORDIA
AL515-00457OtherBCBS PROVIDER NUMBER
AL631260994OtherTAX IDENTIFICATION NUMBER
AL009946890Medicaid