Healthcare Provider Details

I. General information

NPI: 1053007229
Provider Name (Legal Business Name): MAKETA O DIXON MS, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SANGAMORE RD STE 270
BETHESDA MD
20816-2508
US

IV. Provider business mailing address

3 CARRIAGE WALK CT
GAITHERSBURG MD
20879-5512
US

V. Phone/Fax

Practice location:
  • Phone: 240-507-5110
  • Fax:
Mailing address:
  • Phone: 240-306-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX6056
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: