Individual
DR. JOHN R. BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4347 RICE ST STE 202, LIHUE, HI 96766-1335
(808) 245-3582
Mailing address
4347 RICE ST STE 202, LIHUE, HI 96766-1335
(808) 245-3582
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0921
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00087387
HMSA
HI
05
—
06698901
—
HI
01
—
0921
HDS INSURANCE
ID
Enumeration date
03/05/2007
Last updated
07/09/2007
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