MEDICARE: DR. ADAM PRESTON BLOCK DDS

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	122300000X	Dentist	D7541	AZ

General Provider Information

NPI Number	:	1710149398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM PRESTON BLOCK DDS

Provider Business Mailing Address
First Line	:	5398 W MICHELLE DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-1330
Country	:	US
Telephone Number	:	602-402-9538
Fax Number	:

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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