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General NPI Number Information
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NPI Number | 1962697052
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Entity Type | Organization
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Legal Business Name | DIXON FAMILY DENTAL
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD RD SUITE 210
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3709
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Country | US
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Telephone | 248-552-0223
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Fax | 248-552-9868
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Provider Business Mailing Address
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Address Line | 23077 GREENFIELD RD SUITE 210
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3709
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Country | US
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Telephone | 248-552-0223
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Fax | 248-552-9868
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DARLENE T. DANIELS-DIXON
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Credential | DDS
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Telephone | 248-552-0223
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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 | 15753
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License Number State | MI
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