Healthcare Provider Details

I. General information

NPI: 1699121681
Provider Name (Legal Business Name): DIXON FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 N GALENA AVE
DIXON IL
61021-1009
US

IV. Provider business mailing address

1355 N GALENA AVE
DIXON IL
61021-1009
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-1995
  • Fax: 773-887-4294
Mailing address:
  • Phone: 815-284-1995
  • Fax: 773-887-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.028603
License Number StateIL

VIII. Authorized Official

Name: DR. JUBRAIL SWEIS
Title or Position: DENTIST/OWNER
Credential: D.D.S
Phone: 773-844-5283