Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401410755 | VA |
NPI | 1073510624 |
---|---|
Provider Name | Dr. Jennifer Mark Dixon |
First Address | Charlottesville, VA 22903-7899 |
Second Address | Charlottesville, VA 22911-5604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/07/2007 |