Provider Demographics
NPI:1932414265
Name:HIXSON, DAWNYETTA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAWNYETTA
Middle Name:R
Last Name:HIXSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:DAWNYETTA
Other - Middle Name:R
Other - Last Name:MARABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:BUILDING 38801 ACADEMIC DRIVE
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5660
Mailing Address - Country:US
Mailing Address - Phone:706-787-2623
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 38801 ACADEMIC DRIVE
Practice Address - Street 2:SUITE B & C
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5660
Practice Address - Country:US
Practice Address - Phone:706-787-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014150122300000X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No122300000XDental ProvidersDentist