Provider Demographics
NPI:1669698783
Name:DIXON, PENNY S (LMBT)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:S
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323-D EAST MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-3400
Mailing Address - Country:US
Mailing Address - Phone:336-623-7400
Mailing Address - Fax:
Practice Address - Street 1:323-D EAST MEADOW RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-3400
Practice Address - Country:US
Practice Address - Phone:336-623-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC830174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist