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General NPI Number Information
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NPI Number | 1619092194
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Entity Type | Individual
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Provider Name | KENDRA DOREEN BLOCK DDS
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 213 HALLOCK RD SUITE 1
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City | STONY BROOK
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State | NY
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Zip | 11790-3000
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Country | US
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Telephone | 631-689-5411
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SEWARD LN
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City | STONY BROOK
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State | NY
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Zip | 11790-3108
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Country | US
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Telephone | 631-689-0415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 042182
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 042182
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License Number State | NY
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