Provider Demographics
NPI:1508938416
Name:DIXON, ROBERT HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HAROLD
Last Name:DIXON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0849
Mailing Address - Country:US
Mailing Address - Phone:910-897-8952
Mailing Address - Fax:910-897-6646
Practice Address - Street 1:225 MASON ST.
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521
Practice Address - Country:US
Practice Address - Phone:910-897-8952
Practice Address - Fax:910-897-6646
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1032691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992171Medicaid