Provider Demographics
NPI:1639259633
Name:DIXON, STEPHEN T (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
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 1:1315 S MILLER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6910
Mailing Address - Country:US
Mailing Address - Phone:805-348-9188
Mailing Address - Fax:
Practice Address - Street 1:1315 S MILLER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6910
Practice Address - Country:US
Practice Address - Phone:805-348-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics