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JERRY B. BLACK DDS PC NPI 1487696704


NPI Information

NPI: 1487696704
Provider Name: JERRY B. BLACK, DDS, PC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
1925 E 5600 S
SALT LAKE CITY, UT
ZIP 84121
Phone: (801) 278-0458
Get Directions

JERRY B. BLACK, DDS, PC is a general practice dentist in Salt Lake City, UT. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. JERRY B. BLACK, DDS, PC NPI is 1487696704. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1925 E 5600 S
SALT LAKE CITY, UT
ZIP 84121-351
Phone: (801) 278-0458
Fax: (801) 278-0460

The provider's authorized official is Jerry Beck Black .
The authorized official title is President and has the following contact phone number (801) 278-0458.

The enumeration date for this NPI number is 6/12/2006 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
11223G0001XDentistGeneral Practice137953UTAHYes

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
14671OTHERUTAHPEHP

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

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