Healthcare Provider Details

I. General information

NPI: 1891980181
Provider Name (Legal Business Name): REMY VICTOR BLACK DDS, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W. ALPINE 92707 808 E. MANCHESTER BLVD
INGLEWOOD CA
90301-1914
US

IV. Provider business mailing address

PO BOX 10311
TORRANCE CA
90505-1211
US

V. Phone/Fax

Practice location:
  • Phone: 310-872-8408
  • Fax:
Mailing address:
  • Phone: 310-872-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: