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NPI Code Detail

MEDICARE: DR. JEROME V BOCK D.D.S

MEDICARE: DR. JEROME V BOCK D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019021432IL

General Provider Information

NPI Number : 1558695551
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEROME V BOCK D.D.S
Provider Business Mailing Address
First Line : 2232 W ARMITAGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4461
Country : US
Telephone Number : 773-278-0600
Fax Number : 773-278-0666
Provider Business Practice Location Address
First Line : 2232 W ARMITAGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4461
Country : US
Telephone Number : 773-278-0600
Fax Number : 773-278-0666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2009
Last Update Date : 09/23/2009

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