Provider Demographics
NPI:1912927690
Name:DIXON, JOHN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:DIXON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1528
Mailing Address - Country:US
Mailing Address - Phone:304-925-0322
Mailing Address - Fax:304-925-8426
Practice Address - Street 1:3814 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1528
Practice Address - Country:US
Practice Address - Phone:304-925-0322
Practice Address - Fax:304-925-8426
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV23001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice