John R. Black

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0921 Issued in HI

Practice address

4347 Rice St Ste 202
Lihue, HI 96766-1335

Phone

(808) 245-3582

NPI assigned

Mar 5, 2007

Sex

Male

Sole proprietor

Yes

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.

• Garden Island Dental LLC

  • Dental Clinic/Center
  • Lihue, HI
  • NPI 1912591173
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1801925607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4347 RICE ST STE 202",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967661335",
            "telephone_number": "808-245-3582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4347 RICE ST STE 202",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967661335",
            "telephone_number": "808-245-3582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JOHN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "0921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06698901",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HDS INSURANCE",
            "identifier": "0921",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "00087387",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Baker Belding, M.ED., BCBA
• Bennett Jacoby DDS Ms Inc.
• Elvie Rose Bisarra
• Candace H. Bishop
• Alexander Jay Bivens, PH.D.
• Blessed Hands IV Hydration & Wellness LLC
• Blessed Hands Mobile PLLC
• William E. Bodenstab, M.D.
• Kathleen M. Bogdan, M.S.
• Laurie E Bolton, LMT

• All providers in Lihue, HI
• General Practice Dentistry in Hawaii

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.