Provider Demographics
NPI:1720180854
Name:BLOCK, MICHAEL S (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:BLOCK
Suffix:
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 1:110 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005
Mailing Address - Country:US
Mailing Address - Phone:504-833-3368
Mailing Address - Fax:504-831-3331
Practice Address - Street 1:110 VETERANS MEMORIAL BLVD
Practice Address - Street 2:STE 112
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005
Practice Address - Country:US
Practice Address - Phone:504-833-3368
Practice Address - Fax:504-831-3331
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
850000028OtherRR
LA1837598Medicaid
A1893OtherBLUE CROSS
T19752Medicare UPIN
58052Medicare ID - Type Unspecified