Angela Black, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3702 Issued in AR

Practice address

1810 E Highland Dr
Jonesboro, AR 72401-6117

Phone

(870) 972-8075

Fax

(870) 972-8240

NPI assigned

Dec 4, 2008

Last updated

Oct 28, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kool Smiles P.C.

  • General Practice Dentistry
  • Greenville, SC
  • NPI 1235203886
  NPD (past) Authorized official

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

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256688000000",
    "number": "1437394467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67",
            "city": "TAYLORS",
            "state": "SC",
            "postal_code": "296870002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 E HIGHLAND DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724016117",
            "telephone_number": "870-972-8075",
            "fax_number": "870-972-8240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "ANGELA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-04",
        "last_updated": "2009-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4543",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oscar Bishop
• Candas Richmond Bivens, RN
• Ronald J Blachly, M.D.
• Black Box Counseling and Therapeutic Services (Blaqk Box)
• Adrienne Nicole Black, RBT-17-45544
• Ashley Black
• Haley Black, LCSW
• Kristen Black, OD
• Lori Ann Black, ACNPC-AG
• Sarah E Black, LMSW

• General Practice Dentistry in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2009; 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.