MEDICARE: BYRON P DIXON, DDS, PC

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	1223G0001X	General Practice Dentistry	3947	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	813638	OTHER	VA	UNITED CONCORDIA INS

General Provider Information

NPI Number	:	1568500288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BYRON P DIXON, DDS, PC

Provider Business Mailing Address
First Line	:	8808F PEAR TREE VILLAGE CT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-4221
Country	:	US
Telephone Number	:	703-780-2400
Fax Number	:	703-780-6099

Provider Business Practice Location Address
First Line	:	8808F PEAR TREE VILLAGE CT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-4221
Country	:	US
Telephone Number	:	703-780-2400
Fax Number	:	703-780-6099

Authorized Official
Title or Position	:	OWNER
Name	:	BYRON P DIXON
Credential	:	DDS
Telephone Number	:	703-780-2400

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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