Provider Demographics
NPI:1457532376
Name:DIXON, SHANIKA EVETTE (DA)
Entity Type:Individual
Prefix:MS
First Name:SHANIKA
Middle Name:EVETTE
Last Name:DIXON
Suffix:
Gender:F
Credentials:DA
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 6563
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-6563
Mailing Address - Country:US
Mailing Address - Phone:704-924-8960
Mailing Address - Fax:
Practice Address - Street 1:916 MCLAUGHLIN ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-6836
Practice Address - Country:US
Practice Address - Phone:704-924-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant