Provider Demographics
NPI:1235451782
Name:HOWARD R DIXON
Entity Type:Organization
Organization Name:HOWARD R DIXON
Other - Org Name:SAN DIEGO PEDIATRIC DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:858-452-7272
Mailing Address - Street 1:5627 OBERLIN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3748
Mailing Address - Country:US
Mailing Address - Phone:858-452-7272
Mailing Address - Fax:858-452-6022
Practice Address - Street 1:5627 OBERLIN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3748
Practice Address - Country:US
Practice Address - Phone:858-452-7272
Practice Address - Fax:858-452-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty