Provider Demographics
NPI:1881776284
Name:BLACK, HAROLD A (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:A
Last Name:BLACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 ABERCORN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5848
Mailing Address - Country:US
Mailing Address - Phone:912-354-3444
Mailing Address - Fax:912-354-3841
Practice Address - Street 1:6602 ABERCORN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5848
Practice Address - Country:US
Practice Address - Phone:912-354-3444
Practice Address - Fax:912-354-3841
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0062971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice