Provider Demographics
NPI:1942192174
Name:DIXON, JORDAN MATTHEW RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MATTHEW RYAN
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 1:24 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4001
Mailing Address - Country:US
Mailing Address - Phone:918-245-5984
Mailing Address - Fax:918-246-7179
Practice Address - Street 1:24 E 34TH ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4001
Practice Address - Country:US
Practice Address - Phone:918-245-5984
Practice Address - Fax:918-246-7179
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice