DR. CHARLES RANDALL BLACK (NPI# 1205094240) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205094240 |
| Entity Type | Individual |
| Full Name | DR. CHARLES RANDALL BLACK |
| Credential | DMD |
| Practice Address |
26 Long Pond Road Plymouth County Correctional Facility Plymouth MA 02360-2606 |
| Mailing Address |
39 Kathleen Drive Plymouth MA 02360-1630 |
| Practice Telephone | 5088306200 |
| Practice Fax Number | 5088306358 |
| Mailing Telephone | 5082248951 |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2008-05-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
12990 | MA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962555342 | Charles Leonard Black | Emergency Medicine | 7600 General Motors Blvd, Medical Department, Shreveport, LA 71129-9426 | 2007-01-19 |
| 1356407902 | Charles Brad Black | Family Medicine | 214 E 3rd St, Libby, MT 59923-2056 | 2006-12-28 |
| 1053424234 | Charles Glenn Black | Physical Therapist | 1231 Colonial Park Dr, Severn, MD 21144-4417 | 2006-08-15 |
| 1528049723 | Charles Thomas Black | Surgery | 12200 Park Central Dr Ste 400, Dallas, TX 75251-2116 | 2005-11-07 |
| 1972754950 | Charles Black IIi | Dentist | 4728 Airport Blvd, Suite C, Mobile, AL 36608 | 2008-10-08 |
| 1790988087 | Charles Henry Black Iv | Orthopaedic Surgery | 1002 Jefferson St., Suite 350, Laurel, MS 39440-4306 | 2007-06-06 |
| 1427196096 | Charles Alexander Black Jr. | Technician, Other | 427 Commercial St, Boston, MA 02109-1027 | 2007-02-03 |
| 1497764187 | Charles B Black | Surgery | 1010 Three Springs Blvd, Durango, CO 81301-8296 | 2006-08-05 |
| 1730111378 | Charles Joseph Black | Social Worker | 4355 Ferguson Dr, Suite 270, Cincinnati, OH 45245-5136 | 2006-07-06 |
| 1992744981 | Charles Black | Surgery | 1534 Elizabeth Ave, Suite 202, Shreveport, LA 71101-4516 | 2006-06-05 |
| Street Address |
26 LONG POND ROAD PLYMOUTH COUNTY CORRECTIONAL FACILITY |
| City | PLYMOUTH |
| State | MA |
| Zip Code | 02360-2606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801425053 | Geraldine Veronica Thissell | Speech-Language Pathologist | 28 Nathan Lane, Plymouth, MA 02360 | 2020-04-08 |
| 1447889621 | Corrections - Comprehensive Treatment Centers, LLC | Clinic/Center | One Bumps Pond Road, Plymouth, MA 02360 | 2020-04-08 |
| 1427690247 | Osp Children's Therapy Center | Physical Therapist | 130 Industrial Park Rd. A, Plymouth, MA 02360 | 2019-10-14 |
| 1265996219 | Housecall Physicians, Inc | Family Medicine | 31 Home Depot Drive, Suite 283, Plymouth, MA 02360 | 2019-01-24 |
| 1306329271 | Patricia Jane Whitaker | Social Worker | Masac-plymouth, 1 Bumps Pond Road, Plymouth, MA 02360 | 2018-09-07 |
| 1366934572 | Cindy Oneil | Registered Nurse | 10 Cordage Park, Plymouth, MA 02360 | 2018-06-04 |
| 1275021685 | Alexandra Andrew | Acupuncturist | 225 Water St Ste B239, Plymouth, MA 02360 | 2018-05-01 |
| 1417445289 | Susan Ann Adams | Case Manager/Care Coordinator | 260 Ship Pond Rd, Plymouth, MA 02360 | 2018-04-27 |
| 1588178776 | Cassandra Noel Denayer | Registered Nurse | 7 Rodman Lane, Plymouth, MA 02360 | 2017-11-27 |
| 1205345576 | Chibueze George Okoro | Dentist | Dr Dental 125 Samoset Street, Plymouth, MA 02360 | 2017-09-29 |
| Find all providers in zip 02360 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336749522 | Berman Family Dentistry Pllc | Dentist | 9430 S Main St Ste 1, Plymouth, MI 48170-4149 | 2020-10-28 |
| 1649886748 | Advanced Family Dentistry-plymouth Pllc | Dentist | 44644 Ann Arbor Rd W Ste F, Plymouth, MI 48170-4089 | 2020-09-23 |
| 1275003832 | Atsalis Dental Excellence | Dentist | 690 South Main St, Plymouth, MI 48170 | 2018-11-27 |
| 1801387501 | Kwon Yang | Dentist | W 9071 Forest Drive, Plymouth, WI 53073 | 2018-05-29 |
| 1043720675 | Taylor Dental Associates PC | Dentist | 106 Colony Place Rd, Plymouth, MA 02360-7233 | 2017-10-10 |
| 1205345576 | Chibueze George Okoro | Dentist | Dr Dental 125 Samoset Street, Plymouth, MA 02360 | 2017-09-29 |
| 1831565969 | Annelise Nelson | Dentist | 15535 34th Ave N Ste 250, Plymouth, MN 55447-2171 | 2015-08-12 |
| 1467870303 | Paul Boettner Dds Pllc | Dentist | 1485 County Road 101 N, Plymouth, MN 55447-3053 | 2014-03-28 |
| 1083037931 | Nicole Haus | Dentist | 3001 Harbor Ln N Ste 100, Plymouth, MN 55447-8740 | 2014-01-29 |
| 1669743738 | W H Dental, Pllc | Dentist | 17610 19th Ave N, Suite 8, Plymouth, MN 55447-2600 | 2012-01-22 |
| Find all providers in PLYMOUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.