Provider Demographics
NPI:1962526574
Name:DIXON, GERALD EARL (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EARL
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 1:6800 PALM AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4269
Mailing Address - Country:US
Mailing Address - Phone:707-823-8529
Mailing Address - Fax:707-823-7397
Practice Address - Street 1:6800 PALM AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4269
Practice Address - Country:US
Practice Address - Phone:707-823-8529
Practice Address - Fax:707-823-7397
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0221471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice