Individual
RICHARD C BLACK
Active
Individual
RICHARD C BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11053
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009005202
—
TX
05
—
169606401
—
TX
05
—
9177596
—
NM
Enumeration date
03/31/2008
Last updated
03/26/2009
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