MEDICARE: PAVILION DENTAL GROUP, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1568622025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAVILION DENTAL GROUP, LLP

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	9947 W HAPPY VALLEY RD STE 101
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1214
Country	:	US
Telephone Number	:	623-572-0893
Fax Number	:	623-566-0770

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. ADAM P BLOCK
Credential	:	DDS
Telephone Number	:	623-572-0893

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	12/31/2013

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