Provider Demographics
NPI:1134176266
Name:DIXON, THOMAS MALCOLM (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MALCOLM
Last Name:DIXON
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:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:HONEA PATH
Mailing Address - State:SC
Mailing Address - Zip Code:29654
Mailing Address - Country:US
Mailing Address - Phone:864-369-9000
Mailing Address - Fax:864-369-9800
Practice Address - Street 1:512 EAST GREER STREET
Practice Address - Street 2:
Practice Address - City:HONEA PATH
Practice Address - State:SC
Practice Address - Zip Code:29654
Practice Address - Country:US
Practice Address - Phone:864-369-9000
Practice Address - Fax:864-369-9800
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ30413Medicaid