Provider Demographics
NPI:1164634499
Name:BLOCK-HANSEN, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BLOCK-HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 HIGHWAY 6
Mailing Address - Street 2:STE 100
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6055
Mailing Address - Country:US
Mailing Address - Phone:281-499-1618
Mailing Address - Fax:
Practice Address - Street 1:9050 HIGHWAY 6
Practice Address - Street 2:STE 100
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6055
Practice Address - Country:US
Practice Address - Phone:281-499-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13853124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist