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 | 1223G0001X | Dentist | General Practice | 18807 | TEXAS | No |
| 2 | 1223E0200X | Dentist | Endodontics | 18807 | 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 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF NY |
| 2 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF CA |
| 3 | 86-1058804 | OTHER | TEXAS | METLIFE DENTAL |
| 4 | 86-1058804 | OTHER | TEXAS | COMPBENEFITS |
| 5 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF IL |
| 6 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF FL |
| 7 | 86-1058804 | OTHER | TEXAS | HUMANA DENTAL |
| 8 | 86-1058804 | OTHER | TEXAS | DENTAL NETWORK OF AMERICA |
| 9 | 86-1058804 | OTHER | TEXAS | DELTA CARE-PMI |
| 10 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF GA |
| 11 | 86-1058804 | OTHER | TEXAS | PRINCIPAL FINANCIAL GROUP |
| 12 | 86-1058804 | OTHER | TEXAS | AETNA DENTAL |
| 13 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF MA |
| 14 | 86-1058804 | OTHER | TEXAS | AMERITAS PPO DENTAL |
| 15 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF CO |
| 16 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF PA |
| 17 | 86-1058804 | OTHER | TEXAS | CIGNA DENTAL |
| 18 | 86-1058804 | OTHER | TEXAS | GUARDIAN DENTALGUARD |
| 19 | 86-1058804 | OTHER | TEXAS | ASSURANT EMPLOYEE BENEFIT |
| 20 | 86-1058804 | OTHER | TEXAS | DELTA DENTAL OF MO |
