Provider Demographics
NPI:1336636166
Name:DIXON, DESSIE RENEE (RDH)
Entity Type:Individual
Prefix:
First Name:DESSIE
Middle Name:RENEE
Last Name:DIXON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DESSIE
Other - Middle Name:RENEE
Other - Last Name:CARRADINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:9080 CHATWELL CLUB DR APT 2
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-3010
Mailing Address - Country:US
Mailing Address - Phone:810-447-6526
Mailing Address - Fax:
Practice Address - Street 1:9080 CHATWELL CLUB DR APT 2
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-3010
Practice Address - Country:US
Practice Address - Phone:810-447-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902013685124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist