Provider Demographics
NPI:1538337290
Name:DIXON, JANET L (C PED)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:DIXON
Suffix:
Gender:F
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 IRA E WOODS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3906
Mailing Address - Country:US
Mailing Address - Phone:817-416-6155
Mailing Address - Fax:817-886-2567
Practice Address - Street 1:2421 IRA E WOODS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3906
Practice Address - Country:US
Practice Address - Phone:817-416-6155
Practice Address - Fax:817-886-2567
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPED2782247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other