Richard F. Black, DMD., MPH, PC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

DS025700L Issued in PA

Legal business name

RICHARD F. BLACK, DMD., MPH, PC

Practice address

15 Meade St
Suite U5
Wellsboro, PA 16901-1813

Phone

(570) 724-2141

Fax

(570) 724-3942

NPI assigned

Jun 12, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Richard F. Black, DMD., MPH

Title

Owner

Phone

(570) 724-2141

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339459200000",
    "number": "1295097699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MEADE STREET",
            "address_2": "SUITE U5",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "16901",
            "telephone_number": "570-724-2141",
            "fax_number": "570-724-3942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MEADE ST",
            "address_2": "SUITE U5",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011813",
            "telephone_number": "570-724-2141",
            "fax_number": "570-724-3942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD F. BLACK, DMD., MPH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2012-06-12",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-724-2141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD., MPH"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS025700L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010875620001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA BLUE SHIELD",
            "identifier": "141040",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "141040",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Michelle Quezada, DMD
• Jeffrey A Ranta, MD
• Gena L. Rasmussen, MS, RD, LDN
• Chelsey Rendos
• Laura J Rice, M.D.
• Stacey Lea Rodgers, COTA/L
• Seth M Rogers, PT
• Aric Root
• Kari Donnele Root
• Barbara Rouse, PT

• Oral and Maxillofacial Surgery Clinic/Center in Wellsboro, PA
• Providers in Wellsboro, PA by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.

Verify at the official NPI Registry.