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General NPI Number Information
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NPI Number | 1710687470
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Entity Type | Individual
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Provider Name | JACOB DIXON
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Gender | Male
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 232 POND ST
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City | NATICK
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State | MA
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Zip | 01760-4366
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Country | US
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Telephone | 508-319-9339
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Fax |
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-0001
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN10000776
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License Number State | MA
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