Provider Demographics
NPI:1932849973
Name:DIXON, ALEXANDRIA DELYNN
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRIA
Middle Name:DELYNN
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5257 JUDY LYNN CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2547
Mailing Address - Country:US
Mailing Address - Phone:901-598-6371
Mailing Address - Fax:
Practice Address - Street 1:5257 JUDY LYNN CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2547
Practice Address - Country:US
Practice Address - Phone:901-598-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALD.007156-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program