Provider Demographics
NPI:1700962750
Name:BLOCK, NANCY O (DDS)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:O
Last Name:BLOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST WALTON OFFICE CENTER
Mailing Address - Street 2:SUITE 400 EAST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-649-1666
Mailing Address - Fax:312-649-2419
Practice Address - Street 1:100 EAST WALTON OFFICE CENTER
Practice Address - Street 2:SUITE 400 EAST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-649-1666
Practice Address - Fax:312-649-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice