Healthcare Provider Details

I. General information

NPI: 1285420364
Provider Name (Legal Business Name): NATALIE BLACK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N BEDFORD DR STE 215
BEVERLY HILLS CA
90210-4351
US

IV. Provider business mailing address

19825 RIVER FALLS DR
DAVIDSON NC
28036-8869
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-5403
  • Fax:
Mailing address:
  • Phone: 704-574-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number109553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: