Organization
KURT S BLACK DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MCDONALD (BUSINESS ADMINISTRATOR)
(541) 754-0144
Entity
Organization
Contact information
Practice address
2356 NW PROFESSIONAL DR, CORVALLIS, OR 97330-3881
(541) 754-0144
(541) 754-0145
Mailing address
2356 NW PROFESSIONAL DR, CORVALLIS, OR 97330-3881
(541) 754-0144
(541) 754-0145
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6925
OR
Other
Enumeration date
05/08/2008
Last updated
05/08/2008
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