Provider Demographics
NPI:1215930870
Name:HIX, HOWARD RAY SR (DDS)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:RAY
Last Name:HIX
Suffix:SR
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 1:209 W TROY STREET
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4454
Mailing Address - Country:US
Mailing Address - Phone:334-793-7614
Mailing Address - Fax:334-671-4202
Practice Address - Street 1:209 W TROY STREET
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4454
Practice Address - Country:US
Practice Address - Phone:334-793-7614
Practice Address - Fax:334-671-4202
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL93325Medicaid