Healthcare Provider Details

I. General information

NPI: 1699263707
Provider Name (Legal Business Name): LINDA DIXON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N HIGHLAND AVE STE 102
JACKSON TN
38301-3450
US

IV. Provider business mailing address

1105 PLEASANT ST UNIT 421
OAK PARK IL
60302-0007
US

V. Phone/Fax

Practice location:
  • Phone: 731-736-4005
  • Fax:
Mailing address:
  • Phone: 773-456-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number020007044
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH0000008134
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: