Provider Demographics
NPI:1417959966
Name:BLACK, BARBARA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:SUSAN
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 1:119 TIMBER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ZION CROSSROADS
Mailing Address - State:VA
Mailing Address - Zip Code:22942-6981
Mailing Address - Country:US
Mailing Address - Phone:850-803-2134
Mailing Address - Fax:540-432-9097
Practice Address - Street 1:4100 QUARLES CT
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8797
Practice Address - Country:US
Practice Address - Phone:540-432-0609
Practice Address - Fax:540-432-9097
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics