=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396812087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIXON AND THURSTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11616 IBERIA PLACE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-676-5000
-----------------------------------------------------
Fax | 858-676-5016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11616 IBERIA PLACE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-676-5000
-----------------------------------------------------
Fax | 858-676-5016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER HR DIRECTOR
-----------------------------------------------------
Name | MRS. MARY ORDOUKHANIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-676-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------