Healthcare Provider Details

I. General information

NPI: 1568670578
Provider Name (Legal Business Name): DIXON ALAN HAYS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 S CENTRAL AVE
UMATILLA FL
32784-2270
US

IV. Provider business mailing address

285 S. CENTRAL AVE PO BOX 2270
UMATILLA FL
32784-2270
US

V. Phone/Fax

Practice location:
  • Phone: 352-669-3185
  • Fax:
Mailing address:
  • Phone: 352-669-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: