Individual
DR. CHARLES RANDALL BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
26 LONG POND ROAD, PLYMOUTH COUNTY CORRECTIONAL FACILITY, PLYMOUTH, MA 02360-2606
(508) 830-6200
(508) 830-6358
Mailing address
39 KATHLEEN DRIVE, PLYMOUTH, MA 02360-1630
(508) 224-8951
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12990
MA
Other
Enumeration date
05/27/2008
Last updated
05/27/2008
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