Provider Demographics
NPI:1427738012
Name:DIXSON, NAQUITA MICHELLE (DMD)
Entity type:Individual
Prefix:
First Name:NAQUITA
Middle Name:MICHELLE
Last Name:DIXSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BLOEDEL RESERVE WAY APT 304
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-7316
Mailing Address - Country:US
Mailing Address - Phone:404-825-1977
Mailing Address - Fax:
Practice Address - Street 1:1055 PINE LOG RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7396
Practice Address - Country:US
Practice Address - Phone:803-306-7842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice