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 | 1223X0400X | Dentist | Orthodontics and Dentofacial Orthopedics | 2901011253 0936712 | MICHIGAN | No |
| 2 | 122300000X | Dentist | | 2901011253 0935920 | MICHIGAN | Yes |