| Marcus Black, D.D.S., P.A. | |
|
2109 South 54th Street Rogers AR 72758-8195 | |
| (479) 464-0900 | |
| (479) 464-0708 |
| Full Name | Marcus Black, D.D.S., P.A. |
|---|---|
| Speciality | Dentist |
| Location | 2109 South 54th Street, Rogers, Arkansas |
| Authorized Official Name and Position | Marcus Dewitt Black (DENTIST) |
| Authorized Official Contact | 4794640900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marcus Black, D.D.S., P.A. 2109 South 54th Street Rogers AR 72758-8195 Ph: (479) 464-0900 | Marcus Black, D.D.S., P.A. 2109 South 54th Street Rogers AR 72758-8195 Ph: (479) 464-0900 |
| NPI Number | 1699918540 |
|---|---|
| Provider Enumeration Date | 04/08/2009 |
| Last Update Date | 04/08/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699918540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3664 (Arkansas) | Secondary |
| 122300000X | Dentist | 2858 (Arkansas) | Primary |
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