Active NPI
Larry Milton Black Jr., DMD
- General Practice Dentistry
- Quitman, GA
National Provider Identifier
1164558359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN012932
- Practice address
- 1306 E Screven St
Quitman, GA 31643-2318 - Phone
- (229) 263-8700
- Fax
- (229) 263-4212
- NPI assigned
- Feb 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN012932 | GA | Primary |
Addresses
Primary practice location
1306 E Screven St
Quitman, GA 31643-2318
Mailing address
1306 E Screven St
Quitman, GA 31643-2318
Phone (229) 263-8700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN012932 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quitman Family Dentistry LLC | Past | Accepting new patients |
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.
-
- Dental Clinic/Center
- Quitman, GA
- NPI 1639426836
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344902400000",
"number": "1164558359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1306 E SCREVEN ST",
"city": "QUITMAN",
"state": "GA",
"postal_code": "316432318",
"telephone_number": "229-263-8700",
"fax_number": "229-263-4212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1306 E SCREVEN ST",
"city": "QUITMAN",
"state": "GA",
"postal_code": "316432318",
"telephone_number": "229-263-8700",
"fax_number": "229-263-4212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "LARRY",
"middle_name": "MILTON",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-24",
"last_updated": "2012-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN012932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quitman, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.