MEDICARE: BRIAN JERRY BLACK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7386388-9922	UT

General Provider Information

NPI Number	:	1457589483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JERRY BLACK D.D.S.

Provider Business Mailing Address
First Line	:	1925 E 5600 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1351
Country	:	US
Telephone Number	:	801-278-0458
Fax Number	:	801-278-0460

Provider Business Practice Location Address
First Line	:	1925 E 5600 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1351
Country	:	US
Telephone Number	:	801-278-0458
Fax Number	:	801-278-0460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

Similar Medicare Providers

1487696704 — JERRY B. BLACK, DDS, PC
Practice Location Address:

1925 E 5600 S
SALT LAKE CITY, UT
84121-1351

Practice Phone: 801-278-0458
Practice Fax: 801-278-0460

1124062872 — DR. JERRY BECK BLACK D.D.S.
Practice Location Address:

1925 E 5600 S
SALT LAKE CITY, UT
84121-1351

Practice Phone: 801-278-0458
Practice Fax: 801-278-0460

1427278019 — LESTER W CANNON DDS PC
Practice Location Address:

1935 E 5600 S
SALT LAKE CITY, UT
84121-1351

Practice Phone: 801-277-4049
Practice Fax: 801-277-9773

1841547312 — BUXTON DENTISTRY
Practice Location Address:

1925 E 5600 S
SALT LAKE CITY, UT
84121-1351

Practice Phone: 801-278-3214
Practice Fax:

1063595098 — MR. PAUL DAVID HARLEY MSW
Practice Location Address:

807 E SOUTH TEMPLE STE 370
SALT LAKE CITY, UT
84102-1351

Practice Phone: 801-521-0182
Practice Fax: 801-521-0196

1194895136 — INNER TRADITIONS COUNSELING SERVICES
Practice Location Address:

807 E SOUTH TEMPLE STE 370
SALT LAKE CITY, UT
84102-1351

Practice Phone: 801-467-2072
Practice Fax: 801-363-0074

Directions to “ BRIAN JERRY BLACK D.D.S.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.