Provider Demographics
NPI:1831512656
Name:BLOCK, MEGAN ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:BLOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 SW HARBOR WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5164
Mailing Address - Country:US
Mailing Address - Phone:469-387-3104
Mailing Address - Fax:
Practice Address - Street 1:1750 SW HARBOR WAY STE 220
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5164
Practice Address - Country:US
Practice Address - Phone:469-387-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289351223G0001X
ORD106001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice