Provider Demographics
NPI:1609063528
Name:BOCK, JASON TERRY (DDS MS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:TERRY
Last Name:BOCK
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:420 W CENTRAL AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3001
Mailing Address - Country:US
Mailing Address - Phone:714-990-4114
Mailing Address - Fax:714-529-2559
Practice Address - Street 1:420 W CENTRAL AVE
Practice Address - Street 2:SUTIE F
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3001
Practice Address - Country:US
Practice Address - Phone:714-990-4114
Practice Address - Fax:714-529-2559
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA326941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics