Basic Information
| Provider Information | |||||||||
| NPI: | 1447361381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIXON | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6950 NE CAMPUS WAY | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039522125 | ||||||||
| FaxNumber: | 5039522125 | ||||||||
| Practice Location | |||||||||
| Address1: | 4925 SW GRIFFITH DR | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970052923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039522125 | ||||||||
| FaxNumber: | 5039522125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 06/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 820508017 | ID | Y | Dental Providers | Dentist | General Practice | 122300000X | D10222 | OR | N | Dental Providers | Dentist | 122300000X | DE60553642 | WA | N | Dental Providers | Dentist | 122300000X | D1427 | ID | N | Dental Providers | Dentist | 122300000X | 64339 | CA | N | Dental Providers | Dentist |
No ID Information.