Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 10256 | CT |
N | 1223X0400X | Orthodontists | 20732 | MA |
NPI | 1043321342 |
---|---|
Provider Name | Dr. Jeffrey Dixon |
First Address | East Hartford, CT 06108-3228 |
Second Address | East Hartford, CT 06108-3228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0298093 | (05) | MA |