Kevin Black, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30291 Issued in TX

Practice address

2501 65TH St Ste a
Galveston, TX 77551-2218

Phone

(409) 744-4551

Fax

(409) 744-5702

NPI assigned

May 7, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• TX HMO D-SNP
• NM HMO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• KLB Health, PLLC

  • General Practice Dentistry
  • Galveston, TX
  • NPI 1942897301
  NPD Authorized official
• Pediatric Dental Care

  • Pediatric Dentistry
  • Galveston, TX
  • NPI 1104198076
  NPD (past)
• Dental Dreams, LLC

  • General Practice Dentistry
  • Lawrence, MA
  • NPI 1407010531
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622073600000",
    "number": "1013352863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 65TH ST STE A",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775512218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 65TH ST STE A",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775512218",
            "telephone_number": "409-744-4551",
            "fax_number": "409-744-5702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-07",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856252",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "30291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Texas, Inc.
• Susan Timajo Bionat, MSN,ACNP
• Colin Bixler
• Payton Shirlene Bjorkman, DO
• Anita Bjornaas, LCDC
• Kelli Blackwell
• Thomas Adrian Blackwell, MD
• Brandon Blake, PHARMD, RPH
• Channa Blakely
• Ann Blakley, MD

• General Practice Dentistry in Galveston, TX
• Providers in Galveston, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.