Individual
DR. MARK JAMES BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1717 BROADMOOR DR, CHAMPAIGN, IL 61821-5933
(217) 359-1541
Mailing address
1717 BROADMOOR DR, CHAMPAIGN, IL 61821-5933
(217) 359-1541
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-023555
IL
Other
Enumeration date
06/26/2013
Last updated
06/26/2013
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