Provider Demographics
NPI:1891890513
Name:BLOCK, GORDON JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:JAMES
Last Name:BLOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1565 HOLLENBECK AVE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-5922
Mailing Address - Country:US
Mailing Address - Phone:408-739-9700
Mailing Address - Fax:408-739-2617
Practice Address - Street 1:1565 HOLLENBECK AVE
Practice Address - Street 2:SUITE #106
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-5922
Practice Address - Country:US
Practice Address - Phone:408-739-9700
Practice Address - Fax:408-739-2617
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics