Healthcare Provider Details

I. General information

NPI: 1154672178
Provider Name (Legal Business Name): ROBERT BRYAN DIXON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 N SHADELAND AVE
INDIANAPOLIS IN
46250-2021
US

IV. Provider business mailing address

7205 N SHADELAND AVE
INDIANAPOLIS IN
46250-2021
US

V. Phone/Fax

Practice location:
  • Phone: 317-849-0110
  • Fax: 317-845-8845
Mailing address:
  • Phone: 317-849-0110
  • Fax: 317-845-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12009957A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: