Kevin Hale Black, DDS, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in Charlotte, North Carolina. His current practice location is
1000 Blythe Blvd, Charlotte, North Carolina. You can reach out to his office (for appointments etc.) via phone at
(704) 355-2000.
Kevin Hale Black is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1003995085.
Healthcare Provider's Profile
Full Name | Kevin Hale Black |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 1000 Blythe Blvd, Charlotte, North Carolina |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1003995085
- Provider Enumeration Date: 11/02/2006
- Last Update Date: 03/28/2022
Medicare PECOS Information:
- PECOS PAC ID: 2466820261
- Enrollment ID: I20221129002499
Medical Identifiers
Medical identifiers for Kevin Hale Black such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1003995085 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
1223G0001X | Dentist - General Practice | 19705 (Texas) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kevin Hale Black is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Kevin Hale Black, DDS, MD Po Box 32861, Charlotte, NC 28232-2861 Ph: (704) 355-2000 | Kevin Hale Black, DDS, MD 1000 Blythe Blvd, Charlotte, NC 28203-5812 Ph: (704) 355-2000 |
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