Provider Demographics
NPI:1982967832
Name:ELENA BLACK, DDS, PHD, PC
Entity Type:Organization
Organization Name:ELENA BLACK, DDS, PHD, PC
Other - Org Name:APPALACHIAN ORTHODONTICS OF LYNCHBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:434-515-0370
Mailing Address - Street 1:3700 OLD FOREST RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6900
Mailing Address - Country:US
Mailing Address - Phone:434-515-0370
Mailing Address - Fax:434-338-6552
Practice Address - Street 1:3700 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6900
Practice Address - Country:US
Practice Address - Phone:434-515-0370
Practice Address - Fax:434-338-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412779261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental