NPIMap

Organization Active NPI

Dixie Oral, Maxillofacial & Implant Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • St George, UT
National Provider Identifier
1508980848
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
DIXIE ORAL, MAXILLOFACIAL & IMPLANT SURGERY
Practice address
10 Diagonal St
Suite 204
St George, UT 84770-2878
Phone
(435) 673-1554
Fax
(435) 674-9967
NPI assigned
Mar 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. John Hideo Mizukawa, D.D.S.
Title
Oral Surgeon
Phone
(435) 673-1554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

10 Diagonal St
Suite 204
St George, UT 84770-2878

Mailing address

10 Diagonal St
Suite 204
St George, UT 84770-2878
Phone (435) 673-1554

National Provider Directory

National Provider Directory

Locations

1308 E 900 S
Ste A
St George, UT 84790
Phone (435) 673-1554

10 Diagonal St
Ste 204
St George, UT 84770
Phone (435) 652-1556

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508980848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DIAGONAL ST",
            "address_2": "SUITE 204",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847702878",
            "telephone_number": "435-673-1554",
            "fax_number": "435-674-9967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 DIAGONAL ST",
            "address_2": "SUITE 204",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847702878",
            "telephone_number": "435-673-1554",
            "fax_number": "435-674-9967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIXIE ORAL, MAXILLOFACIAL & IMPLANT SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MIZUKAWA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HIDEO",
        "authorized_official_title_or_position": "ORAL SURGEON",
        "authorized_official_telephone_number": "435-673-1554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.