Provider Demographics
NPI:1891042081
Name:ZACHARY DIXON FAMILY DENTAL PA
Entity Type:Organization
Organization Name:ZACHARY DIXON FAMILY DENTAL PA
Other - Org Name:DIXON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT DESK ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-215-4913
Mailing Address - Street 1:1700 UNIVERSITY BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-8004
Mailing Address - Country:US
Mailing Address - Phone:501-215-4913
Mailing Address - Fax:501-354-2458
Practice Address - Street 1:1700 UNIVERSITY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-8004
Practice Address - Country:US
Practice Address - Phone:501-215-4913
Practice Address - Fax:501-354-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty