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General NPI Number Information
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NPI Number | 1467422022
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Entity Type | Individual
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Provider Name | STEVEN WAYNE BLACK DDS
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 48TH MEDICAL GROUP / RAF LAKENHEATH UNIT 5115
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City | APO
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State | AE
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Zip | 09461-5115
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Country | US
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Telephone | 163-852-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 48TH MEDICAL GROUP RAF LAKENHEATH UNIT 5115
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City | APO
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State | AE
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Zip | 09461-5115
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Country | US
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Telephone |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | ENDO-526-17
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D-3652-EN
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License Number State | ID
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