Provider Demographics
NPI:1326732843
Name:MILLERBERG, NATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:MILLERBERG
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 1:543 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3553
Mailing Address - Country:US
Mailing Address - Phone:808-913-7475
Mailing Address - Fax:
Practice Address - Street 1:543 WEST AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3553
Practice Address - Country:US
Practice Address - Phone:970-625-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002062131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice