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NPI Code Detail

MEDICARE: DR. STEVEN W. BLACK DDS

MEDICARE:  DR. STEVEN W. BLACK  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryD6736OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D6736OTHEROROREGON DENTAL LICENSE

General Provider Information

NPI Number : 1174530091
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEVEN W. BLACK DDS
Provider Business Mailing Address
First Line : PO BOX 1891
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-0612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14795 SW MURRAY SCHOLLS DR
Second Line : STE 119
City : BEAVERTON
State : OR
Zip : 97007-9713
Country : US
Telephone Number : 503-524-0524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 08/02/2010

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Directions to “ DR. STEVEN W. BLACK DDS” Practice Location

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