Individual
BRIAN JERRY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1925 E 5600 S, SALT LAKE CITY, UT 84121-1351
(801) 278-0458
(801) 278-0460
Mailing address
1925 E 5600 S, SALT LAKE CITY, UT 84121-1351
(801) 278-0458
(801) 278-0460
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7386388-9922
UT
Other
Enumeration date
06/29/2009
Last updated
06/29/2009
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