NPIMap

Organization Active NPI

Joel a Black Jr DDS PA

  • Pediatric Dentistry
  • Winston Salem, NC
National Provider Identifier
1225074172
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
3648 Issued in NC
Legal business name
JOEL A BLACK JR DDS PA
Practice address
3314 Healy Dr
Suite 104
Winston-Salem, NC 27103-1408
Phone
(336) 765-5421
Fax
(336) 760-9952
NPI assigned
Jun 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Joel A Black Jr., DDSNPI 1427112978
Title
President
Phone
(336) 765-5421

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 3648 NC Primary

Addresses

Primary practice location

3314 Healy Dr
Suite 104
Winston-Salem, NC 27103-1408

Mailing address

3314 Healy Dr
Suite 104
Winston-Salem, NC 27103-1408
Phone (336) 765-5421

Other identifiers 1

IdentifierTypeStateIssuer
90753MedicaidNC

National Provider Directory

National Provider Directory

Locations

3314 Healy Dr
Ste 104
Winston Salem, NC 27103
Phone (336) 765-5421

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225074172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3314 HEALY DR",
            "address_2": "SUITE 104",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271031408",
            "telephone_number": "336-765-5421",
            "fax_number": "336-760-9952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3314 HEALY DR",
            "address_2": "SUITE 104",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271031408",
            "telephone_number": "336-765-5421",
            "fax_number": "336-760-9952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOEL A BLACK JR DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-765-5421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "3648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90753",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.