Provider Demographics
NPI:1487683389
Name:DIXON AND HOLMES DDS, PA
Entity Type:Organization
Organization Name:DIXON AND HOLMES DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:CATES
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-237-8812
Mailing Address - Street 1:2801B WOOTEN BLVD SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8625
Mailing Address - Country:US
Mailing Address - Phone:252-237-8812
Mailing Address - Fax:252-243-9036
Practice Address - Street 1:2801B WOOTEN BLVD SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8625
Practice Address - Country:US
Practice Address - Phone:252-237-8812
Practice Address - Fax:252-243-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6555 AND 66781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990085Medicaid
NC8990082Medicaid
NC8990082Medicaid