Provider Demographics
NPI:1710963822
Name:BLOCH, ELDON GARRETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELDON
Middle Name:GARRETT
Last Name:BLOCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32020 LITTLE BOSTON RD NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9734
Mailing Address - Country:US
Mailing Address - Phone:360-297-9658
Mailing Address - Fax:360-297-9614
Practice Address - Street 1:32020 LITTLE BOSTON RD NE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9734
Practice Address - Country:US
Practice Address - Phone:360-297-9658
Practice Address - Fax:360-297-9614
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice