Individual
DR. MATTHEW KIMBALL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
512 N YOUNG ST, KENNEWICK, WA 99336-7839
(509) 783-7600
(509) 783-0774
Mailing address
512 N YOUNG ST, KENNEWICK, WA 99336-7839
(509) 783-7600
(509) 783-0774
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
61025296
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2015
Last updated
08/28/2020
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