Mark Black, DDS
NPI 1306286034 · on the registry since 2013
Practice
- Address
- 1717 Broadmoor Dr
Champaign, IL 61821 - Phone
- (217) 359-1541
- Organisation at this address
- Gray,Yallaly & Black, D.D.S., Ltd.
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 3
Registry record
- Primary taxonomy
- Dentist
122300000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2013-06-26
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois