Provider Demographics
NPI:1154407963
Name:BLOCH, JEFFREY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:BLOCH
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 1:11777 BERNARDO PLAZA CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2405
Mailing Address - Country:US
Mailing Address - Phone:858-376-1440
Mailing Address - Fax:858-376-1443
Practice Address - Street 1:11777 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2405
Practice Address - Country:US
Practice Address - Phone:858-376-1440
Practice Address - Fax:858-376-1443
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35225OtherDENTAL LICENSE
CA35225OtherDENTAL LICENSE