Provider Demographics
NPI:1609960137
Name:DIX, THOMAS R (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:DIX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 AUSTELL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1844
Mailing Address - Country:US
Mailing Address - Phone:770-732-8374
Mailing Address - Fax:770-732-1033
Practice Address - Street 1:4444 AUSTELL RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1844
Practice Address - Country:US
Practice Address - Phone:770-732-8374
Practice Address - Fax:770-732-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice