Brian Jerry Black, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7386388-9922 Issued in UT

Practice address

1925 E 5600 S
Salt Lake City, UT 84121-1351

Phone

(801) 278-0458

Fax

(801) 278-0460

NPI assigned

Jun 29, 2009

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 UT

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.

• Jerry B. Black, DDS, PC

  • General Practice Dentistry
  • Salt Lake City, UT
  • NPI 1487696704
  NPD (past)

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246233600000",
    "number": "1457589483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 E 5600 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841211351",
            "telephone_number": "801-278-0458",
            "fax_number": "801-278-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 E 5600 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841211351",
            "telephone_number": "801-278-0458",
            "fax_number": "801-278-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "BRIAN",
        "middle_name": "JERRY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2009-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7386388-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BKP Dental
• Black Lab Speech Therapy LLC
• Black Panda LLC
• Megan E Black-Smith, SLP, M.S, CCC
• Alexa Marie Black, LCSW, PMH-C
• Devin Black
• Emma Black
• Heather Black, PSYD
• Jerry Beck Black, D.D.S.
• Karen Sasaki Black, MD

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; 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.