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General NPI Number Information
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NPI Number | 1093048860
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Entity Type | Organization
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Legal Business Name | PAUL P. BOCK DDS INC.
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 4100 PORTOLA DR SUITE 3
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City | SANTA CRUZ
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State | CA
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Zip | 95062-4500
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Country | US
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Telephone | 831-475-1566
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 PORTOLA DR. SUITE 3
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City | SANTA CRUZ
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State | CA
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Zip | 95062-4500
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Country | US
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Telephone | 831-475-1566
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL PHILIP BOCK
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Credential | D.D.S.
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Telephone | 831-475-1566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D20820
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License Number State | CA
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