Provider Demographics
NPI:1992799324
Name:NIXON, BRUCE FREDERICK (DDS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:FREDERICK
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 1:3430 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4710
Mailing Address - Country:US
Mailing Address - Phone:425-259-6551
Mailing Address - Fax:425-258-0477
Practice Address - Street 1:3430 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4710
Practice Address - Country:US
Practice Address - Phone:425-259-6551
Practice Address - Fax:425-258-0477
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
WADE00004521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5516000OtherDEPT OF SOCIAL & HEALTH