Individual
BRENT T. BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1505 EMERALD PLZ, COLLEGE STATION, TX 77845-1501
(979) 764-7101
Mailing address
1505 EMERALD PLZ, COLLEGE STATION, TX 77845-1501
(979) 764-7101
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
36416
TX
Other
Enumeration date
04/09/2020
Last updated
07/15/2024
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