DIXIE ORAL, MAXILLOFACIAL & IMPLANT SURGERY (NPI# 1508980848) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508980848 |
| Entity Type | Organization |
| Organization Name | DIXIE ORAL, MAXILLOFACIAL & IMPLANT SURGERY |
| Practice Address |
10 Diagonal St Suite 204 St George UT 84770-2878 |
| Practice Telephone | 4356731554 |
| Practice Fax Number | 4356749967 |
| Mailing Telephone | 4356731554 |
| Mailing Fax Number | 4356749967 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JOHN HIDEO MIZUKAWA (ORAL SURGEON) |
| Authorized Official Telephone | 4356731554 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Street Address |
10 DIAGONAL ST SUITE 204 |
| City | ST GEORGE |
| State | UT |
| Zip Code | 84770-2878 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730141375 | Russell M Miller | Optometrist | 10 Diagonal St, Suite 101, St George, UT 84770-2878 | 2006-04-06 |
| 1710254792 | Randy T Simonsen | Dentist | 10 Diagonal St, St George, UT 84770-2878 | 2011-11-19 |
| 1245550946 | Eric Ence | Dentist | 10 Diagonal St, Suite 102, St George, UT 84770-2878 | 2010-06-03 |
| 1396919809 | Southern Utah Eye Care Inc | Optometrist | 10 Diagonal St, Ste 101, St George, UT 84770-2878 | 2008-04-15 |
| 1083806004 | Nathan Lee Ence | Dentist | 10 Diagonal St, #102, St George, UT 84770 | 2007-08-14 |
| 1134270655 | Matthew R. Valantine | Dentist | 10 Diagonal St, Ste 201, St George, UT 84770-2878 | 2007-01-12 |
| 1942363148 | Morris Jimmie Wright | Chiropractor | 10 Diagonal St, Ste 204, St George, UT 84770-2817 | 2006-12-18 |
| 1295831691 | John Hideo Mizukawa | Dentist | 10 Diagonal St, Suite 204, St George, UT 84770-2878 | 2006-09-15 |
| 1144232323 | Kent S Albrecht | Optometrist | 10 Diagonal St, Suite 101, St George, UT 84770-2878 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740808500 | Redstone Reference Laboratories Inc | Clinical Medical Laboratory | 556 N Dixie Drive, Suite 2, St George, UT 84770 | 2020-07-08 |
| 1033776315 | Ecko Ashmore | Marriage & Family Therapist | 1173 S. 250 W. Bld 1 Ste 208, St. George, UT 84770 | 2019-05-22 |
| 1740844679 | Amy Darragh | Behavior Technician | 249 E Tabernacle St, Ste 100, St George, UT 84770 | 2019-04-25 |
| 1124598198 | Loren Kyle Gulbranson | Internal Medicine | Dixie Regional Medical Center, 515 South, 300 East, Saint George, UT 84770 | 2018-12-03 |
| 1487150728 | Sound Sleep Medical LLC | Durable Medical Equipment & Medical Supplies | 640 East 700 South Building 2, St. George, UT 84770 | 2018-04-04 |
| 1588162911 | Desert Edge Medical | Family Medicine | 1664 S Dixie Dr Ste D201, St George, UT 84770 | 2018-01-31 |
| 1568981314 | Jeffrey Joseph Peterson | Behavior Technician | 162 N 400 E Ste A-105, St. George, UT 84770 | 2017-09-13 |
| 1992242549 | Zachary Carey | Specialist/Technologist | 1115 W Diamond Valley Dr, Saint George, UT 84770 | 2017-01-20 |
| 1669920427 | Charles Taylor Church | Technician, Other | 474 West 200 East, St. George, UT 84770 | 2016-09-21 |
| 1952755480 | Hollystic Hideaway | Voluntary or Charitable | 1418 W Sunset Blvd. # 2, Saint George, UT 84770 | 2016-04-21 |
| Find all providers in zip 84770 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790012243 | Southern Utah Surgical Arts | Dentist | 393 E Riverside Dr Bldg 2, Suite 2b, St George, UT 84790-7065 | 2009-11-04 |
| 1467916528 | Wisdom Teeth of Southern Utah | Dentist | 446 S Mall Dr Ste 100, St George, UT 84790-4944 | 2019-01-23 |
| 1295831691 | John Hideo Mizukawa | Dentist | 10 Diagonal St, Suite 204, St George, UT 84770-2878 | 2006-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891394631 | Vineyard Oral and Maxillofacial Surgery | Dentist | 707 E Mill Rd Ste 102, Vineyard, UT 84059-5732 | 2020-10-22 |
| 1306489059 | Alpine Dentists and Specialists Pllc | Dentist | 20 W Main Street Ct Ste 100, Alpine, UT 84004-1889 | 2019-10-25 |
| 1194213074 | Lehi Oral Surgery PC | Dentist | 2961 W Maple Loop Dr Ste 130, Lehi, UT 84043-5717 | 2018-04-26 |
| 1568974434 | Utah Wisdom Teeth, LLC | Dentist | 1030 E 11400 S Ste 2a, Sandy, UT 84094-6906 | 2017-10-31 |
| 1447623830 | Great Smiles Dental Clinic LLC | Dentist | 7410 S Creek Rd, #303, Sandy, UT 84093-6140 | 2015-11-06 |
| 1679943831 | Creekside Oral & Facial Surgery Inc | Dentist | 7390 S Creek Rd, Suite 101, Sandy, UT 84093-6119 | 2015-09-30 |
| 1346629441 | Eric Wood | Dentist | 3610 N University Ave Ste 150, Provo, UT 84604-4444 | 2015-05-21 |
| 1023336104 | Adam C Stanley | Dentist | 3632 W South Jordan Pkwy Ste 103, South Jordan, UT 84009-7163 | 2010-05-13 |
| 1487887204 | Joseph Fullmer | Dentist | 493 S Main St # 200, Heber City, UT 84032-2240 | 2009-08-27 |
| 1407085160 | Davis Center for Oral & Maxillofacial Surgery | Dentist | 890 Heritage Park Blvd Ste 103, Layton, UT 84041-5622 | 2009-07-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.