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 | 1223S0112X | Dentist | Oral and Maxillofacial Surgery | 2411 | RHODE ISLAND | 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 | 3381239 | OTHER | RHODE ISLAND | AETNA HMO PAWT |
| 2 | 4002411 | OTHER | RHODE ISLAND | DELTA DENTAL EG |
| 3 | 84475 | OTHER | RHODE ISLAND | BC COVENTRY |
| 4 | 84420 | OTHER | RHODE ISLAND | BC EGREENWICH |
| 5 | 1508 | OTHER | MASSACHUSETTS | DELTA DENTAL OF MASS |
| 6 | 2002411 | OTHER | RHODE ISLAND | DELTA DENTAL PAWTUCKET |
| 7 | 3381239 | OTHER | RHODE ISLAND | AETA HMO PAWT |
| 8 | 83562 | OTHER | RHODE ISLAND | BC PAWTUCKET |
| 9 | 410817 | OTHER | RHODE ISLAND | BLUECHIP |
| 10 | 145484 | OTHER | RHODE ISLAND | UHC SENIOR CARE PAWTUCKET |
| 11 | 3381181 | OTHER | RHODE ISLAND | AETNA HMO EG |
| 12 | 5002411 | OTHER | RHODE ISLAND | DELTA DENTAL COVENTRY |
| 13 | 7017477 | OTHER | RHODE ISLAND | AETNA PPO |
| 14 | 145483 | OTHER | RHODE ISLAND | UHC SENIOR CARE EG |
| 15 | 8000317 | OTHER | RHODE ISLAND | UNITED HEALTH CARE |
| 16 | 145482 | OTHER | RHODE ISLAND | UHC SENIOR CARE COV |
