Provider Demographics
NPI:1932210010
Name:BLOCK & STEVENSON OMS PC
Entity Type:Organization
Organization Name:BLOCK & STEVENSON OMS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-462-9599
Mailing Address - Street 1:911 WALL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2553
Mailing Address - Country:US
Mailing Address - Phone:219-462-9599
Mailing Address - Fax:219-464-0369
Practice Address - Street 1:911 WALL ST
Practice Address - Street 2:SUITE C
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2553
Practice Address - Country:US
Practice Address - Phone:219-462-9599
Practice Address - Fax:219-464-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007573A1223S0112X
IN12008865A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty