Individual
DR. JERRY BECK BLACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1925 E 5600 S, SALT LAKE CITY, UT 84121-1351
(801) 278-0458
(801) 278-0460
Mailing address
8913 RED WILLOW CIR, SANDY, UT 84093-1488
(801) 255-6742
(801) 255-5170
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
137953
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4671
PEHP
UT
Enumeration date
06/15/2006
Last updated
07/08/2007
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