Individual
DR. MARY THERESE BLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DENTIST
Contact information
Practice address
2507 E POPLAR DR, BLOOMINGTON, IN 47401-4327
(812) 322-0065
Mailing address
528 N WALNUT ST, BLOOMINGTON, IN 47404-3804
(812) 332-8030
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12009454
IN
Other
Enumeration date
09/05/2018
Last updated
09/05/2018
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