Provider Demographics
NPI:1720193915
Name:DIXON, JENNIFER JACKSON (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JACKSON
Last Name:DIXON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:155 COLLEGE ST
Mailing Address - Street 2:STE 2
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201
Mailing Address - Country:US
Mailing Address - Phone:478-474-2557
Mailing Address - Fax:478-474-3120
Practice Address - Street 1:155 COLLEGE ST
Practice Address - Street 2:STE 2
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-474-2557
Practice Address - Fax:478-474-3120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0121761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice