Provider Demographics
NPI:1568628857
Name:ANTHONY J. BLACK, D.D.S,,P.C
Entity Type:Organization
Organization Name:ANTHONY J. BLACK, D.D.S,,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-795-8362
Mailing Address - Street 1:9515 WOODY LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12950 HIGHLAND CROSSING DR
Practice Address - Street 2:SUITE F
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-5888
Practice Address - Country:US
Practice Address - Phone:703-787-9670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty