Misty Michelle Black DDS INC
Dentist in Los Angeles, CA. Organization (NPI-2).
NPI number1487946992
StatusActive
Last updated in NPPESMay 3, 2011
Details
- NPI
- 1487946992
- Entity type
- Organization (NPI-2)
- Legal business name
- Misty Michelle Black DDS INC
- Organization subpart
- No
- Enumeration date
- May 3, 2011
- Last updated
- May 3, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 59622 | CA | Yes |
Practice location
3015 Crenshaw Blvd # CLos Angeles, CA 90016-4264
Phone 323-734-1534
Mailing address
3015 Crenshaw Blvd # CLos Angeles, CA 90016-4264
Phone 323-734-1534
Authorized official
Misty Michelle Black
Owner
3237341534
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