Corby M Dixon
Individual provider Active NPI Dentist · Preston, ID
NPI 1265093017 · NPPES record last updated Mar 21, 2024
Key facts
- NPI
- 1265093017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D5018 (ID)
- Practice address
- 395 E 600 S
Preston, ID 83263-4901 - Phone
- (208) 852-0194
- NPI assigned
- Jun 24, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D5018 | ID | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Justin Carter DDS P.C. | Dentist | Current |
Accepting new patients |
Locations
395 E 600 S
Preston, ID 83263
Phone (208) 852-0194
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D5018 | ID | Yes |
Addresses
Primary practice location
395 E 600 S
Preston, ID 83263-4901
Mailing address
6037 Bessinger St
Fort Sill, OK 73503-4406
Phone (580) 442-6106
Other practice location 1
6037 Bessinger St
Fort Sill, OK 73503-4406
Phone (580) 442-6106
Other providers in Preston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.