Provider Demographics
NPI:1679662795
Name:BLACK, JAMES DENNIS (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DENNIS
Last Name:BLACK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1606
Mailing Address - Country:US
Mailing Address - Phone:812-547-5431
Mailing Address - Fax:
Practice Address - Street 1:1044 12TH ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1606
Practice Address - Country:US
Practice Address - Phone:812-547-5431
Practice Address - Fax:812-547-3430
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006251A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice