Fredrico Albert Dixon III, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN014566 Issued in GA

Practice address

7218 Highway 85
Riverdale, GA 30274-2908

Phone

(404) 593-3404

Fax

(404) 228-9673

NPI assigned

Oct 26, 2006

Last updated

May 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sleep Apnea Professionals LLC

  • Dentist
  • Mobile, AL
  • NPI 1396057584
  NPD (past) Authorized official
• Government Dental LLC

  dba Elite Dental Group

  • Dentist
  • Riverdale, GA
  • NPI 1528422524
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590192000000",
    "number": "1396820775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7218 HIGHWAY 85",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742908",
            "telephone_number": "404-593-3404",
            "fax_number": "404-228-9673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7218 HIGHWAY 85",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742908",
            "telephone_number": "404-593-3404",
            "fax_number": "404-228-9673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIXON",
        "first_name": "FREDRICO",
        "middle_name": "ALBERT",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-05-23",
        "certification_date": "2020-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "510DN",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134944F",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "4127424",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Divine Healing Healthcare & Durable Medical Equipment LLC
• Divine Private Home Care Provider
• Divine Source Healthcare Systems, Inc
• Divine Trinity Mobile Lab & CPR Services, LLC
• Barry R Dix, M.S.
• DME of Georgia, Inc
• DME Supply Inc
• Dourron Women's Specialist
• Dr Nimish Patel PC (Riverdale Dental Center)
• Dr.Bostic Private Home Care

• General Practice Dentistry in Riverdale, GA
• Providers in Riverdale, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.