MEDICARE: DR. THOMAS R DIX DMD

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	8413	GA

General Provider Information

NPI Number	:	1609960137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS R DIX DMD

Provider Business Mailing Address
First Line	:	4444 AUSTELL RD STE 200
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-1844
Country	:	US
Telephone Number	:	770-732-8374
Fax Number	:	770-732-1033

Provider Business Practice Location Address
First Line	:	4444 AUSTELL RD STE 200
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-1844
Country	:	US
Telephone Number	:	770-732-8374
Fax Number	:	770-732-1033

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/21/2022

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