Provider Demographics
NPI:1568434611
Name:DIXON, DENNIS CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CARL
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 1:11727 MILLSWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5960
Mailing Address - Country:US
Mailing Address - Phone:210-679-6184
Mailing Address - Fax:
Practice Address - Street 1:220 BERQUIST DR
Practice Address - Street 2:STE 1, ATTN: CREDENTIALS (CMC)
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5300
Practice Address - Country:US
Practice Address - Phone:210-292-6707
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist