John C Black III, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS026798L Issued in PA

Practice address

2600 Willow Street Pike S
Willow Street, PA 17584-9377

Phone

(717) 464-3223

Fax

(717) 464-4150

NPI assigned

Sep 20, 2006

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 PA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Black & Black Dental LLC

  • General Practice Dentistry
  • Willow Street, PA
  • NPI 1689771677
  NPD (past)
• Kent V. Flinchbaugh DPM LTD.

  • Podiatrist
  • Willow Street, PA
  • NPI 1780869644
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477650455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 WILLOW STREET PIKE S",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849377",
            "telephone_number": "717-464-3223",
            "fax_number": "717-464-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 WILLOW STREET PIKE S",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849377",
            "telephone_number": "717-464-3223",
            "fax_number": "717-464-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK III",
        "first_name": "JOHN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS026798L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cole Brian Beckwith, DPT
• Amy Nicole Beelen, MS CCC-SLP
• Leanne K Beidler, M.D.
• Karilyn Grace Bela
• Black & Black Dental LLC
• Connor William Black, DMD
• Corinne Danielle Blackmun, LMSW
• Thomas Dokubo Braide, MD
• Deborah Edler Brennan
• Elizabeth Anne Brown, MS OTR/L

• General Practice Dentistry in Willow Street, PA
• Providers in Willow Street, PA by specialty
• General Practice Dentistry in Pennsylvania

• 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.