Provider Demographics
NPI:1427134873
Name:NIXON, DREXEL MACDOUGAL (DDS)
Entity type:Individual
Prefix:DR
First Name:DREXEL
Middle Name:MACDOUGAL
Last Name:NIXON
Suffix:
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 1:1320 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-1447
Mailing Address - Country:US
Mailing Address - Phone:712-263-2539
Mailing Address - Fax:712-263-6056
Practice Address - Street 1:1320 1ST AVE N
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-1447
Practice Address - Country:US
Practice Address - Phone:712-263-2539
Practice Address - Fax:712-263-6056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA61451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice