Individual
DANTE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4059 WINDY GALE DR N, JACKSONVILLE, FL 32218-4425
(904) 328-6917
Mailing address
4059 WINDY GALE DR N, JACKSONVILLE, FL 32218-4425
(904) 328-6917
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B420161763230
FL
Other
Enumeration date
02/05/2019
Last updated
02/06/2019
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