Provider Demographics
NPI:1821191818
Name:BLACK, DANNY EARL (DMD)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:EARL
Last Name:BLACK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6340
Mailing Address - Country:US
Mailing Address - Phone:806-355-3694
Mailing Address - Fax:
Practice Address - Street 1:1600 S COULTER ST
Practice Address - Street 2:BLDG G, SUITE 500
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1710
Practice Address - Country:US
Practice Address - Phone:806-351-2762
Practice Address - Fax:806-351-2763
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG601311OtherCHIPS
TX147448802Medicaid