MEDICARE: LISA A BLOCK D.M.D., M.S., P.C.

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	1223P0221X	Pediatric Dentistry	6692	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942248521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA A BLOCK D.M.D., M.S., P.C.

Provider Business Mailing Address
First Line	:	3519 56TH ST NW
Second Line	:	SUITE 140
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8593
Country	:	US
Telephone Number	:	253-858-8581
Fax Number	:	253-858-2189

Provider Business Practice Location Address
First Line	:	3519 56TH ST NW
Second Line	:	SUITE 140
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8593
Country	:	US
Telephone Number	:	253-858-8581
Fax Number	:	253-858-2189

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/09/2007

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