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 | 10724 | 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 | D10724 | OTHER | TEXAS | BLUE CROSS BLUE SHIELD |
| 2 | $$$$$$$$$ | OTHER | TEXAS | HUMANA DENTAL |
| 3 | $$$$$$$$$ | OTHER | TEXAS | ASSURANT EMPLOYEE BENEFITS |
| 4 | $$$$$$$$$ | OTHER | TEXAS | SUN LIFE AND HEALTH |
| 5 | $$$$$$$$$ | OTHER | TEXAS | METLIFE |
| 6 | $$$$$$$$$ | OTHER | TEXAS | DELTA DENTAL |
| 7 | $$$$$$$$$ | OTHER | TEXAS | STERLING LIFE INSURANCE |
| 8 | $$$$$$$$$ | OTHER | TEXAS | SAFEHEALTH LIFE INSURANCE |
| 9 | $$$$$$$$$ | OTHER | TEXAS | AFLAC |
| 10 | $$$$$$$$$ | OTHER | TEXAS | HEALTHFIRST TPA |
| 11 | $$$$$$$$$ | OTHER | TEXAS | HEALTHPAYERS USA |
| 12 | $$$$$$$$$ | OTHER | TEXAS | DENTAL NETWORK OF AMERICA |
| 13 | $$$$$$$$$ | OTHER | TEXAS | GUARDIAN |
| 14 | $$$$$$$$$ | OTHER | TEXAS | CIGNA DENTAL |
| 15 | $$$$$$$$$ | OTHER | TEXAS | TRICARE |
| 16 | $$$$$$$$$ | OTHER | TEXAS | BENEFIT PLANNERS |
| 17 | $$$$$$$$$ | OTHER | TEXAS | UMB |
| 18 | 585455 | OTHER | TEXAS | UNITED CONCORDIA |
| 19 | $$$$$$$$$ | OTHER | TEXAS | UNITED HEALTHCARE DENTAL |
| 20 | $$$$$$$$$ | OTHER | TEXAS | WEB TPA |
| 21 | $$$$$$$$$ | OTHER | TEXAS | TML IEBP |
