MEDICARE: DR. DASONJ O NIXON D.D.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	122300000X	Dentist	10172	CT
2	122300000X	Dentist	DS039510	PA

General Provider Information

NPI Number	:	1881925550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DASONJ O NIXON D.D.S

Provider Business Mailing Address
First Line	:	101 S 9TH ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-5108
Country	:	US
Telephone Number	:	717-450-7015
Fax Number	:	717-273-2817

Provider Business Practice Location Address
First Line	:	101 S 9TH ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-5108
Country	:	US
Telephone Number	:	717-450-7015
Fax Number	:	717-273-2817

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

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	11/08/2016

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Directions to “ DR. DASONJ O NIXON D.D.S” Practice Location

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