Paul R Black DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7060 Issued in IA

Legal business name

PAUL R BLACK DDS PC

Practice address

2525 Kimberly Rd Ste 3
Bettendorf, IA 52722-3538

Phone

(563) 359-8271

Fax

(563) 359-8272

NPI assigned

Feb 9, 2017

Last updated

Nov 26, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Paul Ralph Black Jr., DDS, PCNPI 1427101567

Title

Owner

Phone

(563) 359-8271

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul Ralph Black Jr., D.D.S.

  • Dentist
  • Bettendorf, IA
  • NPI 1427101567
  NPD Authorized official

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764115200000",
    "number": "1487192407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 KIMBERLY RD STE 3",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527223538",
            "telephone_number": "563-359-8271",
            "fax_number": "563-359-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 KIMBERLY RD STE 3",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527223538",
            "telephone_number": "563-359-8271",
            "fax_number": "563-359-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL R BLACK DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "RALPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-359-8271",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS, PC"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "7060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alex Parker
• Passport Health Holdings, LLC (Passport Heath)
• David Lee Patch, DC
• Payal T Patel, FNP
• Ishvar B Pattanshetti, MD
• Rachel Paulsen, DPT
• Laura Paxton
• Lori Ann Pedersen, LISW, MAPC
• Sunita Kammila Penmatcha, M.D.
• Susan Barbara Perry, MD

• General Practice Dentistry in Bettendorf, IA
• Providers in Bettendorf, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.