JOEL A BLACK JR DDS PA NPI 1225074172

NPI Information

  • NPI: 1225074172
  • Provider Name: JOEL A BLACK JR DDS PA
  • Classification: Dentist - 1223P0221X
  • Specialization: Pediatric Dentistry
  • Entity Type: Organization
  • Address: 3314 HEALY DR
    SUITE 104
    WINSTON-SALEM, NC
    ZIP 27103
  • Phone: (336) 765-5421

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NPI Details

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
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 Identifier Other Provider Identifier Type Other Provider Identifier State Other 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: 3/30/2025

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