Individual
KENNETH MASON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
427 MEADOWMONT VILLAGE CIR, CHAPEL HILL, NC 27517-7506
(919) 969-9330
(919) 969-2774
Mailing address
1201 LONG GATE WAY, APEX, NC 27502-2242
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6123
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5902391
—
NC
05
—
7990772
—
NC
Enumeration date
03/28/2007
Last updated
07/09/2007
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