Healthcare Provider Details

I. General information

NPI: 1467481606
Provider Name (Legal Business Name): DIXON FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 CANAL AVE SE
NEW PHILADELPHIA OH
44663-2359
US

IV. Provider business mailing address

313 CANAL AVE SE
NEW PHILADELPHIA OH
44663-2359
US

V. Phone/Fax

Practice location:
  • Phone: 330-339-3354
  • Fax: 330-339-7779
Mailing address:
  • Phone: 330-339-3354
  • Fax: 330-339-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17329
License Number StateOH

VIII. Authorized Official

Name: CAROLYN S DIXON
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-339-3354