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General NPI Number Information
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NPI Number | 1063873388
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Entity Type | Organization
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Legal Business Name | DIXON ORTHODONTIC DENTAL GROUP
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 5627 OBERLIN DR STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92121-3748
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Country | US
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Telephone | 858-455-9171
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Fax |
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Provider Business Mailing Address
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Address Line | 5627 OBERLIN DR STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92121-3748
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Country | US
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Telephone | 858-455-9171
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MAY CAMACHO
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Credential | RDA
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Telephone | 858-455-9171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 33593
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 47565
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 46565
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License Number State | CA
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