Provider Demographics
NPI:1275640443
Name:DIXON, LORIN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORIN
Middle Name:E
Last Name:DIXON
Suffix:
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 1:205 ELM ST STE A
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4054
Mailing Address - Country:US
Mailing Address - Phone:208-524-2771
Mailing Address - Fax:208-519-4277
Practice Address - Street 1:205 ELM ST STE A
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4054
Practice Address - Country:US
Practice Address - Phone:208-524-2771
Practice Address - Fax:208-519-4277
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD19751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice