Provider Demographics
NPI:1184014441
Name:BLOCK DENTISTRY
Entity Type:Organization
Organization Name:BLOCK DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:EM
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-440-3222
Mailing Address - Street 1:14070 COMMERCE AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1424
Mailing Address - Country:US
Mailing Address - Phone:952-440-3222
Mailing Address - Fax:952-440-3239
Practice Address - Street 1:14070 COMMERCE AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1424
Practice Address - Country:US
Practice Address - Phone:952-440-3222
Practice Address - Fax:952-440-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9684261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN541722800Medicare PIN