Provider Demographics
NPI:1033679485
Name:DIXON, KARDERRO (DDS)
Entity Type:Individual
Prefix:MR
First Name:KARDERRO
Middle Name:
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 1:25653 HIGHWAY 59 N STE 207
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1797
Mailing Address - Country:US
Mailing Address - Phone:985-856-9279
Mailing Address - Fax:
Practice Address - Street 1:25653 HIGHWAY 59 N STE 207
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1797
Practice Address - Country:US
Practice Address - Phone:832-463-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70251223G0001X
390200000X
TX35869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program