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 | 50805 | CALIFORNIA | 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 | 2958 | OTHER | CALIFORNIA | DENTAL HEALTH SERVICES HM |
| 2 | 57726 | OTHER | CALIFORNIA | HEALTHY FAMILIES/SAFEGUAR |
| 3 | 0005177 | OTHER | CALIFORNIA | MANAGED DENTAL CARE |
| 4 | 012887 | OTHER | CALIFORNIA | PMI DELTACARE |
| 5 | 10393 | OTHER | CALIFORNIA | PACIFICARE DENTAL & VISIO |
| 6 | 1696185 | OTHER | CALIFORNIA | UNITED CONCORDIA |
| 7 | 416735 | OTHER | CALIFORNIA | AETNA DENTAL HMO PLAN |
| 8 | 4538 | OTHER | CALIFORNIA | PACIFIC UNION |
| 9 | 4801 | OTHER | CALIFORNIA | LIBERTY DENTAL PLAN |
| 10 | 11352 | OTHER | CALIFORNIA | CALIFORNIA DENTAL SERVICE |
| 11 | 57565 | OTHER | CALIFORNIA | SAFEGUARD HMO DENTAL PLAN |
| 12 | 2283 | OTHER | CALIFORNIA | CALIFORNIA DENTAL BENEFIT |
| 13 | F3571 | OTHER | CALIFORNIA | GOLDEN WEST HMO PLAN |
| 14 | D1537 | OTHER | CALIFORNIA | SMILESAVER DENTAL PLANS |
| 15 | 120749-1 | OTHER | CALIFORNIA | DENTAL BENEFIT PROVIDER |
| 16 | 1776 | OTHER | CALIFORNIA | CALIFORNIA DENTAL NETWORK |
| 17 | 244931 | OTHER | CALIFORNIA | UNITED DENTAL HEALTHCARE |
