Healthcare Provider Details

I. General information

NPI: 1205815263
Provider Name (Legal Business Name): GARRY J BLOCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7817 IVANHOE AVE STE 305
LA JOLLA CA
92037-4542
US

IV. Provider business mailing address

8112 AUBERGE CIR
SAN DIEGO CA
92127-4204
US

V. Phone/Fax

Practice location:
  • Phone: 858-454-3044
  • Fax:
Mailing address:
  • Phone: 412-657-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDDS060330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: