Individual
MRS. DOROTHY ANNE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
406 BOUGHTON RD, B, BOLINGBROOK, IL 60440
(630) 759-8940
(603) 759-9392
Mailing address
1603 TIMBERLINE DR, JOLIET, IL 60431
(815) 254-9565
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
IL
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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