Provider Demographics
NPI:1154733509
Name:NIXON, CAROL (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 N. JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 106, BLDG 1
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-548-1333
Mailing Address - Fax:
Practice Address - Street 1:927 N. JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 106, BLDG 1
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-548-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190306151223P0221X
390200000X
TN106561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program