Provider Demographics
NPI:1508980848
Name:DIXIE ORAL, MAXILLOFACIAL & IMPLANT SURGERY
Entity Type:Organization
Organization Name:DIXIE ORAL, MAXILLOFACIAL & IMPLANT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HIDEO
Authorized Official - Last Name:MIZUKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-673-1554
Mailing Address - Street 1:10 DIAGONAL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2878
Mailing Address - Country:US
Mailing Address - Phone:435-673-1554
Mailing Address - Fax:435-674-9967
Practice Address - Street 1:10 DIAGONAL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2878
Practice Address - Country:US
Practice Address - Phone:435-673-1554
Practice Address - Fax:435-674-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty