Individual
DR. LARRY MILTON BLACK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1306 E SCREVEN ST, QUITMAN, GA 31643-2318
(229) 263-8700
(229) 263-4212
Mailing address
1306 E SCREVEN ST, QUITMAN, GA 31643-2318
(229) 263-8700
(229) 263-4212
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012932
GA
Other
Enumeration date
02/24/2007
Last updated
08/14/2012
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