JACQUESE OLEAN BLACK DDS NPI 1649387382

NPI Information

NPI: 1649387382
Provider Name: JACQUESE OLEAN BLACK, DDS
Classification: Dentist - 1223G0001X
Specialization: General Practice
Entity Type: Individual
Address: 900 SUMMIT AVE
GREENSBORO, NC
ZIP 27405
Phone: (336) 370-1112

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NPI Details

Jacquese Olean Black, DDS is a general practice dentist in Greensboro, NC. 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. Jacquese Olean Black, DDS NPI is 1649387382. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

900 SUMMIT AVE
GREENSBORO, NC
ZIP 27405-918
Phone: (336) 370-1112
Fax: (336) 544-0739

The enumeration date for this NPI number is 8/25/2006 and was last updated on 7/8/2007.

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
1	1223G0001X	Dentist	General Practice	6204	NORTH CAROLINA	Yes

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
1	90764	OTHER		BLUE CROSS BLUE SHIELD NC
2	89-90764	MEDICAID	NORTH 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: 11/21/2025

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