Kenneth Mason Black, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6123 Issued in NC

Practice address

427 Meadowmont Village Cir
Chapel Hill, NC 27517-7506

Phone

(919) 969-9330

Fax

(919) 969-2774

NPI assigned

Mar 28, 2007

Last updated

Jul 9, 2007By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

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

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.

• Corey W. Wilson DDS PA

  dba Meadowmont Dentistry

  • General Practice Dentistry
  • Chapel Hill, NC
  • NPI 1811084072
  NPD (past)
• Meadowmont Dentistry

  • Durable Medical Equipment & Medical Supplies
  • Chapel Hill, NC
  • NPI 1225678147
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1689793101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 LONG GATE WAY",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275022242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 MEADOWMONT VILLAGE CIR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275177506",
            "telephone_number": "919-969-9330",
            "fax_number": "919-969-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KENNETH",
        "middle_name": "MASON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7990772",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902391",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler Brian Bittner, MD
• Grant Bitzer, PT
• Jenna Lee Bivens, PA
• Jessica Lurie Bizan, NP
• Hannah Black
• Allison Blackburn
• Andrea Mary Blackburn, PT
• Erin L. Blackburn, AU.D.
• Jonathan T Blackburn
• Samuel Neal Blacker, MD

• General Practice Dentistry in Chapel Hill, NC
• Providers in Chapel Hill, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.