Provider Demographics
NPI:1033428982
Name:DIXON, RANDY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:N
Last Name:DIXON
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 1:3400B W 183RD ST # B
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2428
Mailing Address - Country:US
Mailing Address - Phone:708-957-0690
Mailing Address - Fax:708-957-3581
Practice Address - Street 1:3400B W 183RD ST # B
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2428
Practice Address - Country:US
Practice Address - Phone:708-957-0690
Practice Address - Fax:708-957-3581
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist