Provider Demographics
NPI:1770566994
Name:DIXON, JAMES DARRELL (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DARRELL
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 1:835 JOHNSON RD
Mailing Address - Street 2:#37
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-1585
Mailing Address - Country:US
Mailing Address - Phone:478-213-9772
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST
Practice Address - Street 2:BLDG 700A
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice