Misty Michelle Black, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

59622 Issued in CA

Practice address

1000 W Carson St
Oral Surgery Box 19
Torrance, CA 90502-2004

Phone

(310) 668-4675

NPI assigned

Jul 10, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

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.

• Black and to Dental Corporation

  dba Beach City Dental Group

  • Dentist
  • Redondo Beach, CA
  • NPI 1124384417
  NPD (past)

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

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483574400000",
    "number": "1194954180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 HAWTHRONE BLVD. STE #102",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "90278",
            "telephone_number": "310-376-5252",
            "fax_number": "310-376-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W CARSON ST",
            "address_2": "ORAL SURGERY BOX 19",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905022004",
            "telephone_number": "310-668-4675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MISTY",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-10",
        "last_updated": "2017-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "390200000X",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STUDENT, HEALTH CARE",
            "identifier": "390200000X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Briana Sue Black, M.A., CF-SLP
• Freddie De Andrea Black
• James Black, M.D.
• Jason Linville Black, NURSE PRACTITIONER
• Melissa Black
• Tabitha Tamara Black
• Craig Blackston
• Caylin Blake
• John D Blakey, M.D.
• Therese Blanch

• General Practice Dentistry in Torrance, CA
• Providers in Torrance, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; 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.