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General NPI Number Information
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NPI Number | 1225074172
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Entity Type | Organization
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Legal Business Name | JOEL A BLACK JR DDS PA
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3314 HEALY DR SUITE 104
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-1408
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Country | US
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Telephone | 336-765-5421
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Fax | 336-760-9952
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Provider Business Mailing Address
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Address Line | 3314 HEALY DR SUITE 104
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-1408
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Country | US
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Telephone | 336-765-5421
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Fax | 336-760-9952
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL A BLACK JR.
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Credential | DDS
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Telephone | 336-765-5421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3648
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License Number State | NC
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