Provider Demographics
NPI:1962422287
Name:DIX, RUSSELL THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:THOMAS
Last Name:DIX
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 1:426 KELLER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2361
Mailing Address - Country:US
Mailing Address - Phone:817-431-3342
Mailing Address - Fax:817-431-8131
Practice Address - Street 1:426 KELLER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2361
Practice Address - Country:US
Practice Address - Phone:817-431-3342
Practice Address - Fax:817-431-8131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice