Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 122300000X | Dentist | | 20146 | TEXAS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 201047746 | OTHER | | CENTRAL STATES SOUTHEAST AND SOUTHWEST |
| 2 | 201047746 | OTHER | KENTUCKY | DELTA DENTAL OF KENTUCKY |
| 3 | 201047746 | OTHER | TENNESSEE | DELTA DENTAL OF TENNESSEE |
| 4 | 201047746 | OTHER | ILLINOIS | BLUE CROSS BLUE SHIELD OF ILLINOIS |
| 5 | 201047746 | OTHER | ARKANSAS | DELTA DENTAL OF ARKANSAS |
| 6 | 201047746 | OTHER | PENNSYLVANIA | UNITED CONCORDIA |
| 7 | 201047746 | OTHER | OKLAHOMA | BLUE CROSS BLUE SHIELD OF OKLAHOMA |
| 8 | 20104776 | OTHER | TEXAS | HEALTHFIRST TPA |
| 9 | 20104776 | OTHER | NORTH CAROLINA | PRIMARY CARE PHYSICIANS |
| 10 | 201047746 | OTHER | NORTH CAROLINA | COVENTRY HEALTH CARE |
| 11 | 201047746 | OTHER | NEBRASKA | AMERITAS LIFE |
| 12 | 201047746 | OTHER | TEXAS | BLUE CROSS BLUE SHIELD FEDERAL |
| 13 | 201047746 | OTHER | ILLINOIS | LINECO |
| 14 | 201047746 | OTHER | IOWA | ASSURANT |
| 15 | 201047746 | OTHER | ALABAMA | BLUE CROSS BLUE SHIELD OF ALABAMA |
| 16 | 201047746 | OTHER | WASHINGTON | GUARDIAN |
| 17 | 201047746 | OTHER | | CIGNA |
| 18 | 201047746 | OTHER | MICHIGAN | DELTA DENTAL OF MI, OH, IN |
| 19 | 201047746 | OTHER | TENNESSEE | BLUE CROSS BLUE SHIELD OF TENNESSEE |
| 20 | 20104776 | OTHER | TEXAS | WEB TPA |
| 21 | 20104776 | OTHER | VIRGINIA | GENWORTH FINANCIAL |
| 22 | 201047746 | OTHER | MINNESOTA | DELTA DENTAL |
| 23 | 201047746 | OTHER | IOWA | PRINCIPAL LIFE |
| 24 | 201047746 | OTHER | MASSACHUSETTS | SUN LIFE AND HEALTH INS. |
| 25 | 201047746 | OTHER | CALIFORNIA | SAFEHEALTH LIFE INS. |
| 26 | 201047746 | OTHER | TEXAS | METLIFE DENTAL |
| 27 | 201047746 | OTHER | CALIFORNIA | UNICARE |
| 28 | 201047746 | OTHER | MISSOURI | GEHA STATE OF TX DENTAL CHOICE |
| 29 | 201047746 | OTHER | KENTUCKY | HUMANA |
| 30 | 201047746 | OTHER | CALIFORNIA | LIBERTY DENTAL |
| 31 | 20104776 | OTHER | ILLINOIS | DENTAL NETWORK OF AMERICA |
| 32 | 88D834 | OTHER | TEXAS | BLUE CROSS BLUE SHIELD |
| 33 | 201047746 | OTHER | NEW JERSEY | DELTA DENTAL |
| 34 | 201047746 | OTHER | NEW YORK | DELTA DENTAL |
| 35 | 201047746 | OTHER | TEXAS | FISERVHEALTH |
| 36 | 201047746 | OTHER | CALIFORNIA | BC LIFE & HEALTH DENTAL SERVICES |
| 37 | 201047746 | OTHER | UTAH | UNITED HEALTHCARE DENTAL |
| 38 | 201047746 | OTHER | GEORGIA | DELTA DENTAL OF GEORGIA |
| 39 | 201047746 | OTHER | CALIFORNIA | DELTA DENTAL OF CALIFORNIA |
| 40 | 201047746 | OTHER | KENTUCKY | AETNA |
| 41 | 201047746 | OTHER | KANSAS | DELTA DENTAL |
| 42 | 201047746 | OTHER | TEXAS | UMR |
| 43 | 201047746 | OTHER | OKLAHOMA | OLD SURRETY LIFE |
| 44 | 201047746 | OTHER | FLORIDA | COMPBENEFITS |
| 45 | 201047746 | OTHER | IOWA | DELTA DENTAL OF IOWA |
| 46 | 201047746 | OTHER | WASHINGTON | STERLING LIFE INS. CO. |
