Provider Demographics
NPI:1164689378
Name:JAMES L. DIXON, DMD, PS
Entity Type:Organization
Organization Name:JAMES L. DIXON, DMD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LORNE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PS
Authorized Official - Phone:360-479-2240
Mailing Address - Street 1:2520 PERRY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-5219
Mailing Address - Country:US
Mailing Address - Phone:360-479-2240
Mailing Address - Fax:360-792-5952
Practice Address - Street 1:2520 PERRY AVE STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-5219
Practice Address - Country:US
Practice Address - Phone:360-479-2240
Practice Address - Fax:360-792-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4334261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5338504OtherWA STATE DEPT OF SOCIAL AND HEALTH SERVICES
WA8020166Medicaid
WA1457369373OtherINDIVIDUAL NPI NUMBER
WA4335OtherWA STATE DENTAL LICENSE