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General NPI Number Information
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NPI Number | 1215958244
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Entity Type | Organization
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Legal Business Name | ROMNEY R. BLACK DDS PC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 4370 S REDWOOD RD
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City | SALT LAKE CITY
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State | UT
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Zip | 84123-2223
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Country | US
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Telephone | 801-969-1802
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Fax | 801-966-6853
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Provider Business Mailing Address
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Address Line | 6575 SO. REDWOOD RD. #275
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City | SALT LAKE CITY
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State | UT
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Zip | 84123
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Country | US
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Telephone | 801-716-2500
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Fax | 801-716-2503
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | ROMNEY RICHARD BLACK
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Credential | D.D.S.
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Telephone | 801-969-1802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5132937
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License Number State | UT
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