Healthcare Provider Details

I. General information

NPI: 1477620169
Provider Name (Legal Business Name): GORDON HAMILTON DIXON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11616 IBERIA PLACE
SAN DIEGO CA
92128
US

IV. Provider business mailing address

11616 IBERIA PLACE
SAN DIEGO CA
92128
US

V. Phone/Fax

Practice location:
  • Phone: 858-676-5000
  • Fax: 858-676-5016
Mailing address:
  • Phone: 858-676-5000
  • Fax: 858-676-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number24969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: