Provider Demographics
NPI:1174604516
Name:DIXON, LONNIE (RDH)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 26610
Mailing Address - Street 2:BAVARIA DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:DE
Mailing Address - Phone:931-804-3933
Mailing Address - Fax:
Practice Address - Street 1:UNIT 26610
Practice Address - Street 2:BAVARIA DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244
Practice Address - Country:DE
Practice Address - Phone:931-804-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2659124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist