Provider Demographics
NPI:1114396553
Name:DIXON, LAURA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 COURT SQUARE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095
Mailing Address - Country:US
Mailing Address - Phone:662-834-9899
Mailing Address - Fax:662-834-9895
Practice Address - Street 1:302 COURT SQUARE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095
Practice Address - Country:US
Practice Address - Phone:662-834-9899
Practice Address - Fax:662-834-9895
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3820-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist