Provider Demographics
NPI:1831270685
Name:BLOCK, JORDAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:C
Last Name:BLOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 EAST WASHINGTON STREET
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-726-5204
Mailing Address - Fax:312-726-7510
Practice Address - Street 1:55 EAST WASHINGTON STREET
Practice Address - Street 2:SUITE 3200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-726-5204
Practice Address - Fax:312-726-7510
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A128831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice