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General NPI Number Information
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NPI Number | 1265920078
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Entity Type | Individual
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Provider Name | TAKASHI DIXON
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Gender | Female
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 10625 BIG BEND RD
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City | RIVERVIEW
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State | FL
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Zip | 33579
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Country | US
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Telephone | 615-715-6878
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Fax |
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Provider Business Mailing Address
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Address Line | 9430 CERULEAN DR APT 204
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City | RIVERVIEW
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State | FL
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Zip | 33578-4794
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Country | US
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Telephone | 615-715-6878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN24442
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License Number State | FL
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