DR. LARRY J. LAVELETT D.D.S.
Complete NPI Record 1487667093
Dentist - General Practice in Norman, OK

NPI Status: Active since August 14, 2006

Contact Information

443 12TH AVE. N.E.
NORMAN, OK
ZIP 73071
Phone: (405) 360-0018
Fax: (405) 360-1178

Get Directions

Table of Contents

NPI
Entity Type Code
Provider Last Name Legal Name
Provider First Name
Provider Middle Name
Provider Name Prefix Text
Provider Credential Text
Provider First Line Business Mailing Address
Provider Business Mailing Address City Name
Provider Business Mailing Address State Name
Provider Business Mailing Address Postal Code
Provider Business Mailing Address Country Code If outside U S
Provider Business Mailing Address Telephone Number
Provider Business Mailing Address Fax Number
Provider First Line Business Practice Location Address
Provider Business Practice Location Address City Name
Provider Business Practice Location Address State Name
Provider Business Practice Location Address Postal Code
Provider Business Practice Location Address Country Code If outside U S
Provider Business Practice Location Address Telephone Number
Provider Business Practice Location Address Fax Number
Provider Enumeration Date
Last Update Date
Provider Gender Code
Healthcare Provider Taxonomy Code 1
Provider License Number 1
Provider License Number State Code 1
Healthcare Provider Primary Taxonomy Switch 1
Other Provider Identifier 1
Other Provider Identifier Type Code 1
Other Provider Identifier Issuer 1
Other Provider Identifier 2
Other Provider Identifier Type Code 2
Other Provider Identifier Issuer 2
Other Provider Identifier 3
Other Provider Identifier Type Code 3
Other Provider Identifier Issuer 3
Other Provider Identifier 4
Other Provider Identifier Type Code 4
Other Provider Identifier Issuer 4
Other Provider Identifier 5
Other Provider Identifier Type Code 5
Other Provider Identifier Issuer 5
Other Provider Identifier 6
Other Provider Identifier Type Code 6
Other Provider Identifier Issuer 6
Other Provider Identifier 7
Other Provider Identifier Type Code 7
Other Provider Identifier Issuer 7
Other Provider Identifier 8
Other Provider Identifier Type Code 8
Other Provider Identifier Issuer 8
Other Provider Identifier 9
Other Provider Identifier Type Code 9
Other Provider Identifier Issuer 9
Other Provider Identifier 10
Other Provider Identifier Type Code 10
Other Provider Identifier Issuer 10
Other Provider Identifier 11
Other Provider Identifier Type Code 11
Other Provider Identifier Issuer 11
Other Provider Identifier 12
Other Provider Identifier Type Code 12
Other Provider Identifier Issuer 12
Other Provider Identifier 13
Other Provider Identifier Type Code 13
Other Provider Identifier Issuer 13
Other Provider Identifier 14
Other Provider Identifier Type Code 14
Other Provider Identifier Issuer 14
Other Provider Identifier 15
Other Provider Identifier Type Code 15
Other Provider Identifier Issuer 15
Other Provider Identifier 16
Other Provider Identifier Type Code 16
Other Provider Identifier Issuer 16
Other Provider Identifier 17
Other Provider Identifier Type Code 17
Other Provider Identifier Issuer 17
Other Provider Identifier 18
Other Provider Identifier Type Code 18
Other Provider Identifier Issuer 18
Other Provider Identifier 19
Other Provider Identifier Type Code 19
Other Provider Identifier Issuer 19
Other Provider Identifier 20
Other Provider Identifier Type Code 20
Other Provider Identifier Issuer 20
Other Provider Identifier 21
Other Provider Identifier Type Code 21
Other Provider Identifier Issuer 21
Other Provider Identifier 22
Other Provider Identifier Type Code 22
Other Provider Identifier Issuer 22
Other Provider Identifier 23
Other Provider Identifier Type Code 23
Other Provider Identifier Issuer 23
Other Provider Identifier 24
Other Provider Identifier Type Code 24
Other Provider Identifier Issuer 24
Other Provider Identifier 25
Other Provider Identifier Type Code 25
Other Provider Identifier Issuer 25
Other Provider Identifier 26
Other Provider Identifier Type Code 26
Other Provider Identifier Issuer 26
Other Provider Identifier 27
Other Provider Identifier Type Code 27
Other Provider Identifier Issuer 27
Other Provider Identifier 28
Other Provider Identifier Type Code 28
Other Provider Identifier Issuer 28
Other Provider Identifier 29
Other Provider Identifier Type Code 29
Other Provider Identifier Issuer 29
Other Provider Identifier 30
Other Provider Identifier Type Code 30
Other Provider Identifier Issuer 30
Other Provider Identifier 31
Other Provider Identifier Type Code 31
Other Provider Identifier Issuer 31
Other Provider Identifier 32
Other Provider Identifier Type Code 32
Other Provider Identifier Issuer 32
Other Provider Identifier 33
Other Provider Identifier Type Code 33
Other Provider Identifier Issuer 33
Other Provider Identifier 34
Other Provider Identifier Type Code 34
Other Provider Identifier Issuer 34
Other Provider Identifier 35
Other Provider Identifier Type Code 35
Other Provider Identifier Issuer 35
Other Provider Identifier 36
Other Provider Identifier Type Code 36
Other Provider Identifier Issuer 36
Other Provider Identifier 37
Other Provider Identifier Type Code 37
Other Provider Identifier Issuer 37
Other Provider Identifier 38
Other Provider Identifier Type Code 38
Other Provider Identifier Issuer 38
Other Provider Identifier 39
Other Provider Identifier Type Code 39
Other Provider Identifier Issuer 39
Other Provider Identifier 40
Other Provider Identifier Type Code 40
Other Provider Identifier Issuer 40
Other Provider Identifier 41
Other Provider Identifier Type Code 41
Other Provider Identifier Issuer 41
Other Provider Identifier 42
Other Provider Identifier Type Code 42
Other Provider Identifier Issuer 42
Other Provider Identifier 43
Other Provider Identifier Type Code 43
Other Provider Identifier Issuer 43
Other Provider Identifier 44
Other Provider Identifier Type Code 44
Other Provider Identifier Issuer 44
Other Provider Identifier 45
Other Provider Identifier Type Code 45
Other Provider Identifier Issuer 45
Other Provider Identifier 46
Other Provider Identifier Type Code 46
Other Provider Identifier Issuer 46
Other Provider Identifier 47
Other Provider Identifier Type Code 47
Other Provider Identifier Issuer 47
Other Provider Identifier 48
Other Provider Identifier Type Code 48
Other Provider Identifier Issuer 48
Other Provider Identifier 49
Other Provider Identifier Type Code 49
Other Provider Identifier Issuer 49
Other Provider Identifier 50
Other Provider Identifier Type Code 50
Other Provider Identifier Issuer 50
Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1487667093. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1487667093: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Last Name Legal Name: LAVELETT: The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: LARRY: The first name of the provider, if the provider is an individual.
Provider Middle Name: J.: The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: DR.: The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: D.D.S.: The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 443 12TH AVE NE: The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: NORMAN: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OK: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 730715241: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 4053600018: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 4053601178: The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 443 12TH AVE. N.E.: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: NORMAN: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OK: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 730715241: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4053600018: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4053601178: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/14/2006: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 5/14/2008: The date that a record was last updated or changed.
Provider Gender Code: M: The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 1223G0001X: Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 4835: The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: OK: The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 1: BENEFIT PLANNERS
Other Provider Identifier 2: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 2: GUARDIAN
Other Provider Identifier 3: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 3: AIG
Other Provider Identifier 4: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 4: DELTA DENTAL OF RI
Other Provider Identifier 5: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 5: TRISURANT
Other Provider Identifier 6: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 6: DELTA DENTAL OF COLORADO
Other Provider Identifier 7: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 7: CIGNA
Other Provider Identifier 8: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 8: NTCA
Other Provider Identifier 9: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 9: UNICARE
Other Provider Identifier 10: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 10: BROKERS NATIONAL LIFE
Other Provider Identifier 11: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 11: MAILHANDLERS
Other Provider Identifier 12: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 12: DELTA DENTAL OF ARKANSAS
Other Provider Identifier 13: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 13: DELTA DENTAL OF MISSOURI
Other Provider Identifier 14: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 14: DELTA DENTAL OF PA
Other Provider Identifier 15: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 15: DELTA DENTAL USA
Other Provider Identifier 16: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 16: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 16: WATERSTONE
Other Provider Identifier 17: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 17: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 17: AMERITAS
Other Provider Identifier 18: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 18: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 18: APWU
Other Provider Identifier 19: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 19: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 19: HARRINGTON BENEFIT SERVICES
Other Provider Identifier 20: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 20: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 20: QUADMED
Other Provider Identifier 21: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 21: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 21: FMH
Other Provider Identifier 22: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 22: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 22: JEFFERSON PILOT
Other Provider Identifier 23: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 23: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 23: BCBS OF ALABAMA
Other Provider Identifier 24: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 24: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 24: BCBS OF TX
Other Provider Identifier 25: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 25: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 25: HUMANA DENTAL
Other Provider Identifier 26: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 26: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 26: MUTUAL ASSURANCE
Other Provider Identifier 27: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 27: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 27: UNITED MEDICAL RESOURCES
Other Provider Identifier 28: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 28: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 28: GREAT CORNERSTONE
Other Provider Identifier 29: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 29: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 29: BCBS OF ILLINOIS
Other Provider Identifier 30: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 30: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 30: DELTA DENTAL
Other Provider Identifier 31: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 31: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 31: KEMPTON GROUP ADMIN, INC.
Other Provider Identifier 32: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 32: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 32: UNITED HEALTHCARE
Other Provider Identifier 33: 4835
Other Provider Identifier Type Code 33: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 33: WASHINGTON DENTAL SERVICES
Other Provider Identifier 34: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 34: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 34: CENTRAL STATES FUNDS
Other Provider Identifier 35: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 35: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 35: FORTIS
Other Provider Identifier 36: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 36: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 36: OSMA
Other Provider Identifier 37: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 37: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 37: BLUE CROSS/BLUE SHIELD
Other Provider Identifier 38: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 38: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 38: BLUE CROSS/BLUE SHIELD FEDERAL
Other Provider Identifier 39: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 39: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 39: EMPLOYERS GROUP INSURANCE
Other Provider Identifier 40: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 40: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 40: GEHA
Other Provider Identifier 41: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 41: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 41: METLIFE
Other Provider Identifier 42: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 42: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 42: UNITED CONCORDIA
Other Provider Identifier 43: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 43: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 43: DELTA DENTAL OF NEW JERSEY
Other Provider Identifier 44: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 44: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 44: AETNA
Other Provider Identifier 45: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 45: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 45: PRINCIPAL
Other Provider Identifier 46: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 46: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 46: ASSURANT
Other Provider Identifier 47: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 47: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 47: DELTA DENTAL OF CALIFORNIA
Other Provider Identifier 48: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 48: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 48: AMERICAN HEALTH GROUP, INC
Other Provider Identifier 49: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 49: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 49: DELTA DENTAL OF ILLINOIS
Other Provider Identifier 50: 4835: Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 50: 01: Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 50: CSCS
Is Sole Proprietor: Y: Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No