Provider Demographics
NPI:1093817314
Name:DIXON ORTHODONTICS LLC
Entity Type:Organization
Organization Name:DIXON ORTHODONTICS LLC
Other - Org Name:JEFFREY DIXON DBA DIXON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:413-774-1713
Mailing Address - Street 1:63 FRENCH KING HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301
Mailing Address - Country:US
Mailing Address - Phone:413-774-1713
Mailing Address - Fax:413-774-3516
Practice Address - Street 1:63 FRENCH KING HIGHWAY
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301
Practice Address - Country:US
Practice Address - Phone:413-774-1713
Practice Address - Fax:413-774-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9743341Medicaid