Active NPI
Doris J Black, DDS
- General Practice Dentistry
- Swansboro, NC
National Provider Identifier
1962512368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4877
- Practice address
- 200 718A West Corbett Avenue
Swansboro, NC 28584 - Phone
- (910) 326-3611
- Fax
- (910) 326-1122
- NPI assigned
- Aug 30, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4877 | NC | Primary |
Addresses
Primary practice location
200 718A West Corbett Avenue
Swansboro, NC 28584
Mailing address
718A West Corbett Avenue
Swansboro, NC 28584
Phone (910) 326-3611
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8990759 | Medicaid | NC | |
| 0269C | Other | NC | BCBS |
| 3224 | Other | NC | DELTA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4877 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anderson and Slack and Associates | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Swansboro, NC
- NPI 1750485165
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962512368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "718A WEST CORBETT AVENUE",
"city": "SWANSBORO",
"state": "NC",
"postal_code": "28584",
"telephone_number": "910-326-3611",
"fax_number": "910-326-1122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 718A WEST CORBETT AVENUE",
"city": "SWANSBORO",
"state": "NC",
"postal_code": "28584",
"telephone_number": "910-326-3611",
"fax_number": "910-326-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "DORIS",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "4877",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8990759",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0269C",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA",
"identifier": "3224",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Swansboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.