Provider Demographics
NPI:1891810339
Name:DIXON, SCOTT E (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:DIXON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MERVYN
Other - Middle Name:J
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1620 SE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2528
Mailing Address - Country:US
Mailing Address - Phone:954-523-8788
Mailing Address - Fax:954-523-7999
Practice Address - Street 1:1620 SE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2528
Practice Address - Country:US
Practice Address - Phone:954-523-8788
Practice Address - Fax:954-523-7999
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice