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JOEL A BLACK JR DDS PA NPI 1225074172


NPI Information

NPI: 1225074172
Provider Name: JOEL A BLACK JR DDS PA
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
3314 HEALY DR
SUITE 104
WINSTON-SALEM, NC
ZIP 27103
Phone: (336) 765-5421
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JOEL A BLACK JR DDS PA is a pediatric dentistry dentist in Winston-salem, NC. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. JOEL A BLACK JR DDS PA NPI is 1225074172. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3314 HEALY DR
SUITE 104
WINSTON-SALEM, NC
ZIP 27103-408
Phone: (336) 765-5421
Fax: (336) 760-9952

The provider's authorized official is Joel A Black .
The authorized official title is President and has the following contact phone number (336) 765-5421.

The enumeration date for this NPI number is 6/21/2006 and was last updated on 8/22/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0221XDentistPediatric Dentistry3648NORTH CAROLINAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
190753MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.