Jerry B. Black, DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

137953 Issued in UT

Legal business name

JERRY B. BLACK, DDS, PC

Practice address

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

Phone

(801) 278-0458

Fax

(801) 278-0460

NPI assigned

Jun 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Beck Black, D.D.S.NPI 1124062872

Title

President

Phone

(801) 278-0458

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry Beck Black, D.D.S.

  • Dentist
  • Salt Lake City, UT
  • NPI 1124062872
  NPD (past) Authorized official
• Brian Jerry Black, D.D.S.

  • General Practice Dentistry
  • Salt Lake City, UT
  • NPI 1457589483
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487696704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8913 RED WILLOW CIR",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840931488",
            "telephone_number": "801-255-6742",
            "fax_number": "801-255-5170"
        },
        {
            "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": {
        "organization_name": "JERRY B. BLACK, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "BECK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-278-0458",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "137953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "4671",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate Jerez
• Tyson R. Jergensen, MD
• Zachary R. Jergensen, MD
• Scott Michael Jerome, PT
• Jerrica Lavooy LLC
• Jerry L. Gearheart
• Christy A. Jesme, MD
• Jared Craig Jesperson, DDS
• Jess Aranda LLC
• Jesse Jesse Cruz

• 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 Aug 22, 2020; 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.