Provider Demographics
NPI:1083625099
Name:VICE, DINAH BLACK (DDS)
Entity Type:Individual
Prefix:MRS
First Name:DINAH
Middle Name:BLACK
Last Name:VICE
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 1:1801 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-929-3996
Mailing Address - Fax:919-942-0146
Practice Address - Street 1:1801 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5855
Practice Address - Country:US
Practice Address - Phone:919-929-3996
Practice Address - Fax:919-942-0146
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist