Provider Demographics
NPI:1134136773
Name:MILBERG, DIANE JOYCE (DDS MSD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:JOYCE
Last Name:MILBERG
Suffix:
Gender:F
Credentials:DDS MSD
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:JOYCE
Other - Last Name:REIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:306 WALNUT AVE
Mailing Address - Street 2:#33
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-299-3560
Mailing Address - Fax:619-299-0552
Practice Address - Street 1:306 WALNUT AVE
Practice Address - Street 2:#33
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-299-3560
Practice Address - Fax:619-299-0552
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist