Provider Demographics
NPI:1164511127
Name:DIXON, JERALD ALLEN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:ALLEN
Last Name:DIXON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 SHELTON BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2754
Mailing Address - Country:US
Mailing Address - Phone:251-675-3354
Mailing Address - Fax:251-675-3451
Practice Address - Street 1:224 SHELTON BEACH RD
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2754
Practice Address - Country:US
Practice Address - Phone:251-675-3354
Practice Address - Fax:251-675-3451
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice