Active NPI
Garry J Bloch, DMD
- Periodontics
- La Jolla, CA
National Provider Identifier
1205815263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DDS060330
- Practice address
- 7817 Ivanhoe Ave Ste 305
La Jolla, CA 92037-4542 - Phone
- (858) 454-3044
- NPI assigned
- Jan 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DDS060330 | CA | Primary |
Addresses
Primary practice location
7817 Ivanhoe Ave Ste 305
La Jolla, CA 92037-4542
Mailing address
8112 Auberge Cir
San Diego, CA 92127-4204
Phone (412) 657-4804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160315001488 | PA | Order and Referring Only - Other (Physician) | 1052617263 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS060330 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732147200000",
"number": "1205815263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8112 AUBERGE CIR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921274204",
"telephone_number": "412-657-4804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7817 IVANHOE AVE STE 305",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920374542",
"telephone_number": "858-454-3044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOCH",
"first_name": "GARRY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2024-11-21",
"certification_date": "2024-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "DDS060330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.