Provider Demographics
NPI:1053327965
Name:MARBERGER, DOUGLAS RILEY BERT (D,DS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RILEY BERT
Last Name:MARBERGER
Suffix:
Gender:M
Credentials:D,DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166EAST4600SOUTH
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5946
Mailing Address - Country:US
Mailing Address - Phone:801-392-4940
Mailing Address - Fax:
Practice Address - Street 1:166 E 4600 S
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-5946
Practice Address - Country:US
Practice Address - Phone:801-392-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12990399221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice