Nan Monroe Black, D.D.S.

Key facts

NPI

1083843544

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

4160 (AR)

Practice address

14810 Cantrell Rd Ste 150
Little Rock, AR 72223-4681

Phone

(501) 673-3905

NPI assigned

Jul 6, 2009

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Fruchey Dental, PLLC Dental Clinic/Center · Little Rock, AR · NPI 1487300612
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

Other names

• Dr. Nan Elizabeth Monroe Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 11, 2018.

{
    "created_epoch": "1246838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515628800000",
    "number": "1083843544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14810 CANTRELL RD STE 150",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722234681",
            "telephone_number": "501-673-3905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14810 CANTRELL RD STE 150",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722234681",
            "telephone_number": "501-673-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "NAN",
        "middle_name": "MONROE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-06",
        "last_updated": "2018-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3580-11",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "4160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NAN",
            "last_name": "MONROE",
            "middle_name": "ELIZABETH",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Little Rock, AR

• Christina Black, MHPP
• David Albritton Black, MD
• Jaime Paige Black, PT, DPT
• Jasmine Black
• Jennifer Black, MHPP
• Ronda Black
• Sherry Black, APN
• Hannah Blackketter
• Blackmon Care Home Care
• Blackmon Chiropractic Clinic, P.a.

All providers in Little Rock, AR · General Practice Dentistry in Arkansas