Provider Demographics
NPI:1063412849
Name:NIX, DONALD V (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:V
Last Name:NIX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5501 INDEPENDENCE PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5469
Mailing Address - Country:US
Mailing Address - Phone:972-985-7555
Mailing Address - Fax:972-964-5193
Practice Address - Street 1:5501 INDEPENDENCE PKWY #104
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023
Practice Address - Country:US
Practice Address - Phone:972-985-7555
Practice Address - Fax:972-964-5193
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD12607Medicare ID - Type Unspecified