Provider Demographics
NPI:1205849189
Name:DIXON FAMILY DENTISTRY PA
Entity Type:Organization
Organization Name:DIXON FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-583-6613
Mailing Address - Street 1:26 PARKWAY BLVD
Mailing Address - Street 2:DIXON FAMILY DENTISTRY
Mailing Address - City:HATTISBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401
Mailing Address - Country:US
Mailing Address - Phone:601-583-6613
Mailing Address - Fax:601-583-9832
Practice Address - Street 1:26 PARKWAY BLVD
Practice Address - Street 2:DIXON FAMILY DENTISTRY
Practice Address - City:HATTISBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-583-6613
Practice Address - Fax:601-583-9832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1579731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty