Provider Demographics
NPI:1104999267
Name:BLOCK, MICHAEL JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:BLOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:951 BROKEN SOUND PKWY NW
Mailing Address - Street 2:SUITE 185
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3507
Mailing Address - Country:US
Mailing Address - Phone:561-999-9650
Mailing Address - Fax:561-998-8340
Practice Address - Street 1:1200 NW 51ST ST
Practice Address - Street 2:A4
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4426
Practice Address - Country:US
Practice Address - Phone:561-997-9930
Practice Address - Fax:561-997-9949
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN16136122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice