Individual
DR. JANETTE A. BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
69 SHERMAN ST, FAIRFIELD, CT 06824-5821
(203) 255-1545
Mailing address
867 RIVERSIDE DR, FAIRFIELD, CT 06824-6936
(203) 815-5665
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8994
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8994
DENTAL LICENSE
CT
Enumeration date
07/29/2006
Last updated
12/07/2016
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