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Individual

DR. ERNEST LAVON NIX JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
216 BRENDA DR, SHREVEPORT, LA 71115-3004
(318) 797-8869

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1697-75
MS

Other

Enumeration date
07/14/2006
Last updated
07/08/2007
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