Provider Demographics
NPI:1992809149
Name:BLACK, NARVEL ATWOOD JR (DMD)
Entity type:Individual
Prefix:DR
First Name:NARVEL
Middle Name:ATWOOD
Last Name:BLACK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:JEMISON
Mailing Address - State:AL
Mailing Address - Zip Code:35085
Mailing Address - Country:US
Mailing Address - Phone:205-688-4408
Mailing Address - Fax:205-688-4409
Practice Address - Street 1:25210 US HWY 31 NORTH
Practice Address - Street 2:
Practice Address - City:JEMISON
Practice Address - State:AL
Practice Address - Zip Code:35085
Practice Address - Country:US
Practice Address - Phone:205-688-4408
Practice Address - Fax:205-688-4408
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL090470OtherBCBS
AL402814OtherUNITED CONCORDIA