DR. HARRISON BLACK (NPI# 1750780052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750780052 |
| Entity Type | Individual |
| Full Name | DR. HARRISON BLACK |
| Credential | D.M.D |
| Practice Address |
3305 E Douglas Ave Ste 101 Wichita KS 67218-1037 |
| Practice Telephone | 3162234455 |
| Practice Fax Number | 3162234455 |
| Mailing Telephone | 1632234455 |
| Mailing Fax Number | 3162234455 |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2019-08-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 1267 | FL | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
61482 | KS | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DN21749 | FL | Dental Providers |
| Street Address |
3305 E DOUGLAS AVE STE 101 |
| City | WICHITA |
| State | KS |
| Zip Code | 67218-1037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114544392 | Diana Ho | Optometrist | 980 Oliver Street, Wichita, KS 67218 | 2020-07-03 |
| 1134773690 | Lily Lopez | Nurse's Aide | 5107 E Kellogg Drive, Wichita, KS 67218 | 2019-08-01 |
| 1750862512 | Kelsi Wenger | Student in an Organized Health Care Education/Training Program | 5500 E Kellog Dr, Wichita, KS 67218 | 2018-08-28 |
| 1770038937 | Hair Replacement Clinic | Specialist | 1815 S Windsor, Wichita, KS 67218 | 2016-08-17 |
| 1457757346 | South Wind Women's Centter, LLC | Clinic/Center | 5701 E Kellogg Drive, Wichita, KS 67218 | 2014-11-05 |
| 1124460787 | Teri Kitchen | Social Worker | 3414 Kinkaid, Wichita, KS 67218 | 2013-07-24 |
| 1053660142 | Glenda Rodgers-lawless, Ph.d., Lcpc, Pa | Community/Behavioral Health | 4601 E Douglas, Wichita, KS 67218 | 2012-09-05 |
| 1649541848 | Stephen Rhinehart | Registered Nurse | 5500 E Kellogg Dr., Wichita, KS 67218 | 2012-01-19 |
| 1457666927 | Recovery Services Council Inc. | Point of Service | 1611 South Rutan, Wichita, KS 67218 | 2010-08-09 |
| 1043535867 | Melissa A Weinley | Respiratory Therapist, Registered | 5500 East Kellog Dr, Wichita, KS 67218 | 2010-04-05 |
| Find all providers in zip 67218 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093911513 | Matthew Healy | Dentist | 3933 N. Maize Rd, Ml 2006, Wichita, KS 67205-3039 | 2007-06-22 |
| 1245370345 | Kidspace Pediatric Dentistry,p.a | Dentist | 430 N Woodlawn St Ste 1, Wichita, KS 67208-4334 | 2007-02-07 |
| 1619983681 | Crystal Rachelle Walker | Dentist | 6943 W 37th St N, Wichita, KS 67205-9302 | 2006-07-31 |
| 1205891355 | Hoanh Ba Le | Dentist | 430 N Woodlawn St, Wichita, KS 67208-4300 | 2006-04-20 |
| 1376519439 | Stephen Phillip Moore | Dentist | 356 N Rock Rd, Wichita, KS 67206-2200 | 2006-02-27 |
| 1578553285 | Michael Francis Iseman | Dentist | 1230 N Broadmoor Ave, Suite 400, Wichita, KS 67206-3891 | 2005-10-24 |
| 1679041644 | Tiny Teeth Pediatric Dentistry, LLC | Dentist | 3933 N. Maize Rd, Suite 200, Wichita, KS 67205-6710 | 2018-11-08 |
| 1295071231 | Childrens Dentistry of Wichita | Dentist | 2143 N Collective Ln, Suite B, Wichita, KS 67206-3504 | 2012-12-19 |
| 1811266042 | Children's Dental Professionals | Dentist | 6943 W 37th St N, Wichita, KS 67205-9302 | 2011-12-16 |
| 1013193028 | Crystal Walker, Dds, Pa | Dentist | 6943 W 37th St N, Wichita, KS 67205-9302 | 2008-01-21 |
| Find all providers in WICHITA | ||||
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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.