Provider Demographics
NPI:1023272291
Name:DIXON, STEPHEN FREDERICK (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FREDERICK
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 1:1218 FILER AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4117
Mailing Address - Country:US
Mailing Address - Phone:208-733-4515
Mailing Address - Fax:208-733-2757
Practice Address - Street 1:1218 FILER AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4117
Practice Address - Country:US
Practice Address - Phone:208-733-4515
Practice Address - Fax:208-733-2757
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-41371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice