Mansfield Dixon Jr., DMD
Individual provider Active NPI General Practice Dentistry · Pineville, KY
NPI 1811056302 · NPPES record last updated Aug 14, 2007
Key facts
- NPI
- 1811056302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4873 (KY)
- Practice address
- 121 W Virginia Ave
Pineville, KY 40977-1600 - Phone
- (606) 337-3034
- Fax
- (606) 337-5305
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 4873 | KY | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4873 | KY | |
| General Practice Dentistry | 1223G0001X | 4873 | KY | Yes |
Addresses
Primary practice location
121 W Virginia Ave
Pineville, KY 40977-1600
Mailing address
121 W Virginia Ave
Pineville, KY 40977-1600
Phone (606) 337-3034
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45001468 | Medicaid | KY | |
| 60048733 | Medicaid | KY |
Other providers in Pineville, KY
- Joanne D. Corum
- County of Bell
- Rebecca Nicole Crisp
- Cumberland Valley District Health Department
- Dialysis Services of Pineville LLC
- Dr. Kathryn Lefevers
- Dr. Mary Jean Gambrel, M.D., General Psychiatry, Pllcc
- Echo Analyzing, Inc.
- Sandra Elliott
- Emanuel H. Rader, P.S.C.
All providers in Pineville, KY · General Practice Dentistry in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2007. 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.