Provider Demographics
NPI:1093048860
Name:PAUL P. BOCK DDS INC.
Entity Type:Organization
Organization Name:PAUL P. BOCK DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-475-1566
Mailing Address - Street 1:4100 PORTOLA DR.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4500
Mailing Address - Country:US
Mailing Address - Phone:831-475-1566
Mailing Address - Fax:
Practice Address - Street 1:4100 PORTOLA DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4500
Practice Address - Country:US
Practice Address - Phone:831-475-1566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD208201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty