PROVIDER TYPE CODE PROVIDER SPECIALTY CODE …
062-Endodontics 1223E0200X 001-General Practice 1223G0001X 212-Oral Maxillofacial Surgery 1223S0112X 064-Orthodontics 1223X0400X 063-Pedodontics (Pediatric Dentistry) 1223P0221X 065-Periodontics 1223P0300X 066-Prosthodontics 1223P0700X 013-Dietary & Nutritional Service Providers 056-Licensed Registered Dietician 133V00000X 411-Optician 156FX1800X
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