MEDICARE: DR. DOUGLAS A DIX D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	17956	OH

General Provider Information

NPI Number	:	1780704718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS A DIX D.D.S.

Provider Business Mailing Address
First Line	:	5451 MONTGOMERY ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212
Country	:	US
Telephone Number	:	513-631-6600
Fax Number	:	513-458-3492

Provider Business Practice Location Address
First Line	:	5451 MONTGOMERY ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212
Country	:	US
Telephone Number	:	513-631-6600
Fax Number	:	513-458-3492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	03/01/2019

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