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General NPI Number Information
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NPI Number | 1962664383
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Entity Type | Organization
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Legal Business Name | DIXON DENTAL CENTER
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 205 ELM ST SUITE A
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City | IDAHO FALLS
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State | ID
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Zip | 83402-4054
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Country | US
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Telephone | 208-524-2771
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Fax | 208-529-4277
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Provider Business Mailing Address
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Address Line | 205 ELM ST SUITE A
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City | IDAHO FALLS
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State | ID
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Zip | 83402-4054
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Country | US
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Telephone | 208-524-2771
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Fax | 208-529-4277
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Authorized Official
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Title or Position | OWNER
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Name | DR. LORIN E DIXON
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Credential | D.M.D.
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Telephone | 208-524-2771
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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 | D1975
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License Number State | ID
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