Individual
EMILY PETTIT BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
157 HOLLAND AVE, WESTOVER, WV 26501
(304) 296-1721
Mailing address
440 OVERHILL ST, MORGANTOWN, WV 26505-4825
(304) 610-6542
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4266
WV
Other
Enumeration date
03/30/2017
Last updated
07/08/2018
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