Gregory Black, DDS
Individual provider Active NPI Dentist · Hurricane, WV
NPI 1790987337 · NPPES record last updated Oct 29, 2012
Key facts
- NPI
- 1790987337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- WV3055 (WV)
- Practice address
- 203 Chase Dr
Hurricane, WV 25526-8938 - Phone
- (304) 757-7792
- NPI assigned
- Jun 5, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WV3055 | WV | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kerry Kendrick, DDS, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | WV3055 | WV | Yes |
Addresses
Primary practice location
203 Chase Dr
Hurricane, WV 25526-8938
Mailing address
143 Candlewyck Dr
Hurricane, WV 25526-8813
Phone (304) 444-7358
Other providers in Hurricane, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.