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General NPI Number Information
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NPI Number | 1356638910
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Entity Type | Individual
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Provider Name | JENNIFER MICHELLE BLACK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 233 S 13TH ST
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City | LINCOLN
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State | NE
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Zip | 68508-2017
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Country | US
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Telephone | 712-326-5340
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Fax |
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Provider Business Mailing Address
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Address Line | 209 PARKVIEW DR
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-5300
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Country | US
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Telephone | 712-326-5340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7879
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08831
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License Number State | IA
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