Provider Demographics
NPI:1043321342
Name:DIXON, JEFFREY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 CONNECTICUT BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3228
Mailing Address - Country:US
Mailing Address - Phone:602-899-3978
Mailing Address - Fax:
Practice Address - Street 1:477 CONNECTICUT BLVD STE 105
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3228
Practice Address - Country:US
Practice Address - Phone:860-289-9397
Practice Address - Fax:860-528-3129
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207321223X0400X
CT102561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0298093Medicaid
NH30304282Medicaid