MEDICARE: DR. JEFFREY DIXON DDS, M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	20732	MA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10256	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043321342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY DIXON DDS, M.S.

Provider Business Mailing Address
First Line	:	477 CONNECTICUT BLVD STE 105
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	602-899-3978
Fax Number	:

Provider Business Practice Location Address
First Line	:	477 CONNECTICUT BLVD STE 105
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	860-289-9397
Fax Number	:	860-528-3129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/08/2021

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