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 | 1223P0221X | Dentist | Pediatric Dentistry | DS026384L | PENNSYLVANIA | 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 | 51022 | OTHER | DELAWARE | DELTA DENTAL OF DE |
| 2 | CDM10 | OTHER | MICHIGAN | DELTA DENTAL OF MI |
| 3 | 04614 | OTHER | MASSACHUSETTS | DELTA DENTAL OF MA |
| 4 | 39069 | OTHER | WISCONSIN | DELTA DENTAL OF WI |
| 5 | 05029 | OTHER | RHODE ISLAND | DELTA DENTAL OF RI |
| 6 | 02027 | OTHER | VERMONT | DELTA DENTAL OF VT |
| 7 | 11198 | OTHER | NEW YORK | DELTA DENTAL OF NY |
| 8 | 22189 | OTHER | NEW JERSEY | DELTA DENTAL OF NJ |
| 9 | 94276 | OTHER | GEORGIA | DELTA DENTAL GA |
| 10 | CDTN1 | OTHER | TENNESSEE | DELTA DENTAL OF TN |
| 11 | 43090 | OTHER | MISSOURI | DELTA DENTAL OF MO |
| 12 | 23166 | OTHER | PENNSYLVANIA | DELTA DENTAL OF PA |
| 13 | 54084 | OTHER | VIRGINIA | DELTA DENTAL OF VA |
| 14 | 77777 | OTHER | CALIFORNIA | DELTA DENTAL OF CA |
| 15 | 91062 | OTHER | WASHINGTON | DELTA DENTAL OF WA |
| 16 | CDOH1 | OTHER | OHIO | DELTA DENTAL OF OH |
| 17 | 86027 | OTHER | ARIZONA | DELTA DENTAL OF AR |
| 18 | 84056 | OTHER | COLORADO | DELTA DENTAL OF CO |
| 19 | CDIA1 | OTHER | IOWA | DELTA DENTAL OF IA |
| 20 | 05030 | OTHER | ILLINOIS | DELTA DENTAL OF IL |
| 21 | 22189 | OTHER | CONNECTICUT | DELTA DENTAL OF CT |
| 22 | 56101 | OTHER | NORTH CAROLINA | DELTA DENTAL OF NC |
| 23 | CDMN1 | OTHER | MINNESOTA | DELTA DENTAL OF MN |
| 24 | CDKS1 | OTHER | KANSAS | DELTA DENTAL OF KS |
| 25 | CDOK1 | OTHER | OKLAHOMA | DELTA DENTAL OF OK |
