Misty Michelle Black DDS Inc

Primary specialty

DentistTaxonomy code 122300000X

License

59622 Issued in CA

Legal business name

MISTY MICHELLE BLACK DDS INC

Practice address

3015 Crenshaw Blvd # C
Los Angeles, CA 90016-4264

Phone

(323) 734-1534

NPI assigned

May 3, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Misty Michelle Black, DDS

Title

Owner

Phone

(323) 734-1534

Specialties & licenses 1

Addresses

Tax ID family

Edward E Black Ddsmsinc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Edward E Black DDS,Ms,Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Los Angeles, CA
  • NPI 1508010497
  NPD tax ID

Locations

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304380800000",
    "number": "1487946992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 CRENSHAW BLVD # C",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900164264",
            "telephone_number": "323-734-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 CRENSHAW BLVD # C",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900164264",
            "telephone_number": "323-734-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISTY MICHELLE BLACK DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-03",
        "last_updated": "2011-05-03",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-734-1534",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "59622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Mistretta
• Anushay Mistry, MD
• Nidhi Jajoo Mistry, DPT, PCS
• Porus Darayus Mistry, MD
• Rashna Mistry, MA, CCC-SLP
• Harry Hiroshi Mita, PT
• Mitanaur Anesthesia Services Inc
• Gladys Mitani, PHARM. D.
• Shane Mitbo
• Mitch Golant, PHD, Clinical Psychologist, a Professional Corporation

• Dentist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; 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.