Provider Demographics
NPI:1942248521
Name:BLOCK, LISA A (DMD, MS, PC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BLOCK
Suffix:
Gender:F
Credentials:DMD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 56TH ST NW
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8593
Mailing Address - Country:US
Mailing Address - Phone:253-858-8581
Mailing Address - Fax:253-858-2189
Practice Address - Street 1:3519 56TH ST NW
Practice Address - Street 2:SUITE 140
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8593
Practice Address - Country:US
Practice Address - Phone:253-858-8581
Practice Address - Fax:253-858-2189
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA66921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5013925Medicaid