Provider Demographics
NPI:1568975233
Name:DIXON, BARBARA LEATHERMAN (RDH, BS, MED)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LEATHERMAN
Last Name:DIXON
Suffix:
Gender:F
Credentials:RDH, BS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S WAKARA WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1213
Mailing Address - Country:US
Mailing Address - Phone:801-581-8102
Mailing Address - Fax:
Practice Address - Street 1:530 S WAKARA WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1213
Practice Address - Country:US
Practice Address - Phone:801-587-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112413-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist