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 1:8112 AUBERGE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-4204
Mailing Address - Country:US
Mailing Address - Phone:412-657-4804
Mailing Address - Fax:
Practice Address - Street 1:7817 IVANHOE AVE STE 305
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4542
Practice Address - Country:US
Practice Address - Phone:858-454-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS0603301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics