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General NPI Number Information
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NPI Number | 1114173077
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Entity Type | Organization
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Legal Business Name | LISA A BLOCK, DMD, MS, PC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 3519 56TH ST NW SUITE 140
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City | GIG HARBOR
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State | WA
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Zip | 98335-8593
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Country | US
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Telephone | 253-858-8581
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Fax | 253-858-2189
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Provider Business Mailing Address
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Address Line | 3519 56TH ST NW SUITE 140
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City | GIG HARBOR
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State | WA
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Zip | 98335-8593
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Country | US
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Telephone | 253-858-8581
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Fax | 253-858-2189
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISA A BLOCK
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Credential | DMD, MS
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Telephone | 253-858-8581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6846
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 6692
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License Number State | WA
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