Provider Demographics
NPI:1285628263
Name:DIXON, WANDA (RDH)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 QUACKENBOS ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1912
Mailing Address - Country:US
Mailing Address - Phone:202-433-2480
Mailing Address - Fax:
Practice Address - Street 1:166 BUCHANAN ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374
Practice Address - Country:US
Practice Address - Phone:202-433-2480
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC124Q00000X124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1526OtherHYGIENIST