Organization
RICHARD F. BLACK, DMD., MPH, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD F. BLACK DMD., MPH (OWNER)
(570) 724-2141
Entity
Organization
Contact information
Practice address
15 MEADE ST, SUITE U5, WELLSBORO, PA 16901-1813
(570) 724-2141
(570) 724-3942
Mailing address
15 MEADE STREET, SUITE U5, WELLSBORO, PA 16901
(570) 724-2141
(570) 724-3942
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
DS025700L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010875620001
—
PA
01
—
141040
PA BLUE SHIELD
PA
Enumeration date
06/12/2012
Last updated
06/12/2012
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