Individual
JHARED BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
135 HENSON CT, MATTESON, IL 60443-3012
(708) 743-9685
Mailing address
3677 SAUK TRL, RICHTON PARK, IL 60471-1461
(708) 481-2288
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019030918
IL
1223G0001X
General Practice Dentistry
12013820A
IN
Other
Enumeration date
08/08/2016
Last updated
07/02/2025
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