Provider Demographics
NPI:1396812087
Name:DIXON AND THURSTON
Entity type:Organization
Organization Name:DIXON AND THURSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER HR DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDOUKHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-676-5000
Mailing Address - Street 1:11616 IBERIA PLACE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:858-676-5000
Mailing Address - Fax:858-676-5016
Practice Address - Street 1:11616 IBERIA PLACE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:858-676-5000
Practice Address - Fax:858-676-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
173912OtherUNITED CONCORDIA INS
CAD33462Medicaid
809272OtherUNITED CONCORDIA INS