Healthcare Provider Details

I. General information

NPI: 1215059969
Provider Name (Legal Business Name): THOMAS M DIXON DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E GREER ST
HONEA PATH SC
29654-1823
US

IV. Provider business mailing address

PO BOX 183 512 E GREER ST
HONEA PATH SC
29654-0183
US

V. Phone/Fax

Practice location:
  • Phone: 864-369-9000
  • Fax: 864-369-9800
Mailing address:
  • Phone: 864-369-9000
  • Fax: 864-369-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3041
License Number StateSC

VIII. Authorized Official

Name: DR. THOMAS MALCOLM DIXON
Title or Position: OWNER
Credential:
Phone: 864-369-9000