Individual
DR. W MICHAEL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1375 E 800 N, SUITE 103, OREM, UT 84097
(801) 225-2310
(801) 225-6840
Mailing address
1375 E 800 N, SUITE 103, OREM, UT 84097
(801) 225-2310
(801) 225-6840
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1403839922
UT
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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