Healthcare Provider Details

I. General information

NPI: 1053322776
Provider Name (Legal Business Name): MICHAEL BENJAMIN DIXON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 E WILSON ST
FARMVILLE NC
27828
US

IV. Provider business mailing address

PO BOX 774
FARMVILLE NC
27828
US

V. Phone/Fax

Practice location:
  • Phone: 252-753-2218
  • Fax: 252-753-2218
Mailing address:
  • Phone: 252-753-2218
  • Fax: 252-753-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4187
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: