Orthodontics and Dentofacial Orthopedics (1223X0400X)
Credentials listed
DDS
License number on NPI record
30021148 (OH)
NPI first issued
Oct 25, 2006
NPI record last updated
Oct 24, 2017
NPI 1104901677 is active in the federal NPPES registry (CMS) with Orthodontics and Dentofacial Orthopedics, an ADA-recognized dental specialty, as its primary taxonomy; license 30021148 (OH) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Orthodontists are dentists who completed an accredited orthodontic residency after dental school. General dentists can also offer braces or aligners, but they are not listed here.
Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Orthodontics lists board-certified orthodontists.