Provider Demographics
NPI:1205815263
Name:BLOCH, GARRY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:J
Last Name:BLOCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-2407
Mailing Address - Country:US
Mailing Address - Phone:412-391-3003
Mailing Address - Fax:412-391-3494
Practice Address - Street 1:355 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2409
Practice Address - Country:US
Practice Address - Phone:412-391-3003
Practice Address - Fax:412-391-3494
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021239L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics