Provider Demographics
NPI:1760593024
Name:DIXON, MICHAEL EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EVAN
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 1:1601 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-2450
Mailing Address - Country:US
Mailing Address - Phone:574-952-0674
Mailing Address - Fax:
Practice Address - Street 1:410 YEARICK ST
Practice Address - Street 2:
Practice Address - City:ARGOS
Practice Address - State:IN
Practice Address - Zip Code:46501-1036
Practice Address - Country:US
Practice Address - Phone:574-892-5513
Practice Address - Fax:574-892-5279
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice