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NPI Code Detail

MEDICARE: ALLEN L BLACK DMD

MEDICARE: ALLEN L BLACK DMD
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
11223G0001XGeneral Practice Dentistry16723OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10423OTHEROHDENTIST

General Provider Information

NPI Number : 1861401655
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLEN L BLACK DMD
Provider Business Mailing Address
First Line : 500 RUSCHMAN DR
Second Line :
City : COLD SPRING
State : KY
Zip : 41076-9273
Country : US
Telephone Number : 859-441-5562
Fax Number :
Provider Business Practice Location Address
First Line : 7535 STATE RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45255-2438
Country : US
Telephone Number : 513-231-5444
Fax Number : 513-231-8135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 07/08/2007

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Directions to “ ALLEN L BLACK DMD” Practice Location

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