Provider Demographics
NPI:1669588778
Name:PHYLLIS A. DIXON DDS PC
Entity type:Organization
Organization Name:PHYLLIS A. DIXON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-629-8770
Mailing Address - Street 1:17W620 14TH ST
Mailing Address - Street 2:STE. G
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3768
Mailing Address - Country:US
Mailing Address - Phone:630-629-8770
Mailing Address - Fax:630-871-0484
Practice Address - Street 1:17W620 14TH ST
Practice Address - Street 2:STE. G
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3768
Practice Address - Country:US
Practice Address - Phone:630-629-8770
Practice Address - Fax:630-871-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental