# EDWARD E BLACK DDS,MS,INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508010497
- **Authorized official:** MARIA ORELLANA (OFFICE MANAGER)
- **Authorized official phone:** (323) 734-1534

## Contact information

- **Practice address:** 3015 CRENSHAW BLVD, SUITE C, LOS ANGELES, CA 90016-4264
- **Practice address phone:** (323) 734-1534
- **Practice address fax:** (323) 734-4693
- **Mailing address:** 3015 CRENSHAW BLVD, SUITE C, LOS ANGELES, CA 90016-4264
- **Mailing address phone:** (323) 734-1534
- **Mailing address fax:** (323) 734-4693

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 17879 | CA | Yes |

## Other

- **Enumeration date:** 11/05/2008
- **Last updated:** 11/05/2008