Organization
JOEL A BLACK JR DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL A BLACK JR. DDS (PRESIDENT)
(336) 765-5421
Entity
Organization
Contact information
Practice address
3314 HEALY DR, SUITE 104, WINSTON-SALEM, NC 27103-1408
(336) 765-5421
(336) 760-9952
Mailing address
3314 HEALY DR, SUITE 104, WINSTON-SALEM, NC 27103-1408
(336) 765-5421
(336) 760-9952
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3648
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90753
—
NC
Enumeration date
06/21/2006
Last updated
08/22/2020
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