Provider Demographics
NPI:1275552341
Name:GARRY J. BLOCH DMD LLC
Entity Type:Organization
Organization Name:GARRY J. BLOCH DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-391-3003
Mailing Address - Street 1:355 5TH AVE STE 1110
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:SUITE 1110
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS21239L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1319942OtherUNITED CONCORDIA PROVIDER