Provider Demographics
NPI:1740317148
Name:BOCK, EUGENE D (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:D
Last Name:BOCK
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 1:1260 15TH STREET
Mailing Address - Street 2:SUITE #707
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-459-9222
Mailing Address - Fax:310-458-6773
Practice Address - Street 1:1260 15TH STREET
Practice Address - Street 2:SUITE #707
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-458-9292
Practice Address - Fax:310-458-6773
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADA0222021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice