Jerry Beck Black, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

137953 Issued in UT

Practice address

1925 E 5600 S
Salt Lake City, UT 84121-1351

Phone

(801) 278-0458

Fax

(801) 278-0460

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Jerry B. Black, DDS, PC

  • General Practice Dentistry
  • Salt Lake City, UT
  • NPI 1487696704
  NPD (past) Authorized official

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1124062872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8913 RED WILLOW CIR",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840931488",
            "telephone_number": "801-255-6742",
            "fax_number": "801-255-5170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 E 5600 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841211351",
            "telephone_number": "801-278-0458",
            "fax_number": "801-278-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JERRY",
        "middle_name": "BECK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "137953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "4671",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexa Marie Black, LCSW, PMH-C
• Brian Jerry Black, D.D.S.
• Devin Black
• Emma Black
• Heather Black, PSYD
• Karen Sasaki Black, MD
• Kathryn Olivia Black
• Kristen Black, DPT
• Madison T. Black, MD, MPH
• Mike A Black, CEPS, NREMT

• Dentist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.