Provider Demographics
NPI:1881618668
Name:GREEN-DIXIE, KIYA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KIYA
Middle Name:
Last Name:GREEN-DIXIE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5639 VININGS PLACE TRL
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5681
Mailing Address - Country:US
Mailing Address - Phone:404-322-5585
Mailing Address - Fax:404-344-0695
Practice Address - Street 1:3650 MARKETPLACE BLVD
Practice Address - Street 2:SUITE #920
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5741
Practice Address - Country:US
Practice Address - Phone:404-344-5585
Practice Address - Fax:404-344-0695
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics