Provider Demographics
NPI:1043571300
Name:BLACK, CLAIRE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:L
Last Name:BLACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 BLYTHE STREET CT STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4054
Mailing Address - Country:US
Mailing Address - Phone:828-692-3933
Mailing Address - Fax:828-692-9946
Practice Address - Street 1:687 BLYTHE STREET CT STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4054
Practice Address - Country:US
Practice Address - Phone:828-692-3933
Practice Address - Fax:828-692-9946
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice