Kurt S. Black, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6925 Issued in OR

Practice address

2356 NW Professional Dr
Corvallis, OR 97330-3881

Phone

(541) 754-0144

Fax

(541) 754-0145

NPI assigned

Sep 15, 2005

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 20, 2013 through Aug 20, 2027

Medicare enrollment (NPD)

Not 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.

• Kurt S Black DDS, PC

  • General Practice Dentistry
  • Corvallis, OR
  • NPI 1427225549
  NPD (past)

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186358400000",
    "number": "1497740427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2356 NW PROFESSIONAL DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303881",
            "telephone_number": "541-754-0144",
            "fax_number": "541-754-0145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2356 NW PROFESSIONAL DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303881",
            "telephone_number": "541-754-0144",
            "fax_number": "541-754-0145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KURT",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2007-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Bittner
• Alex Bitz, CADC II
• Lisa J Bjornstad, CADC
• Black Stone Health PC
• Dalton Black
• Mary Ellen Black, M.D.
• Katherine J Blackwelder
• Emma Bryanne Blake, RN
• Josie Blakeney
• Monica Rose Blalock

• General Practice Dentistry in Corvallis, OR
• Providers in Corvallis, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.