John Thomas Black Jr., D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2066-84 Issued in MS

Practice address

209 S Main St
Pontotoc, MS 38863-3319

Phone

(662) 489-7768

Fax

(877) 698-4592

NPI assigned

Oct 12, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MS

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Main Dental Clinic, LLC

  dba South Main Dental

  • General Practice Dentistry
  • Pontotoc, MS
  • NPI 1043756687
  NPD (past) Authorized official

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376632943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 539",
            "address_2": "209 S MAIN ST",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388630539",
            "telephone_number": "662-489-7768",
            "fax_number": "877-698-4592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 S MAIN ST",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388633319",
            "telephone_number": "662-489-7768",
            "fax_number": "877-698-4592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2066-84",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Athletico, LTD (Athletico Physical Therapy)
• Jo Baker, LCSW
• Shonve Ball, FNP
• Andrew Bell, DPT
• Brittany Lashae Bevill, MS CCC-SLP
• Boa Vida Hospital of Aberdeen, Ms LLC (MRH Medical Group, Acute Care and Family Clinic of Pontotoc)
• Hannah Gaskin Boatright, LCSW
• Brittani Boatwright, PTA
• Monye Bowdry
• Breanna Renee Bray, NP

• General Practice Dentistry in Pontotoc, MS
• Providers in Pontotoc, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.