Provider Demographics
NPI:1497036271
Name:GARY D DIXON DDS PLLC
Entity Type:Organization
Organization Name:GARY D DIXON DDS PLLC
Other - Org Name:DIXON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-430-4200
Mailing Address - Street 1:405 CENTER DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8626
Mailing Address - Country:US
Mailing Address - Phone:303-430-4200
Mailing Address - Fax:
Practice Address - Street 1:1075 E SOUTH BOULDER RD
Practice Address - Street 2:SUITE 235
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-2560
Practice Address - Country:US
Practice Address - Phone:303-430-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty