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NPI 1487696449

NPI 1487696449 : JAMES JOSEPH DIXSON DDS : LIBERTY, MO

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General NPI Number Information
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    NPI Number           |    1487696449
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    Entity Type          |    Individual 
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    Provider Name        |    JAMES JOSEPH DIXSON DDS
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    06/12/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    1508 NE 96TH ST SUITE A
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    City                 |    LIBERTY
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    State                |    MO
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    Zip                  |    64068-1348
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    Country              |    US
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    Telephone            |    816-415-8080
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    Fax                  |    816-415-8083
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Provider Business Mailing Address
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    Address Line         |    1508 NE 96TH ST SUITE A
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    City                 |    LIBERTY
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    State                |    MO
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    Zip                  |    64068-1348
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    Country              |    US
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    Telephone            |    816-415-8080
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    Fax                  |    816-415-8083
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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        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    015821
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    License Number State |    MO
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