Provider Demographics
NPI:1477668218
Name:FIREBERG, DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FIREBERG
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 1:1772 STAUCH DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324
Mailing Address - Country:US
Mailing Address - Phone:248-360-7766
Mailing Address - Fax:
Practice Address - Street 1:2811 E COURT ST
Practice Address - Street 2:SUITE I
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506
Practice Address - Country:US
Practice Address - Phone:810-232-2920
Practice Address - Fax:810-232-1054
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016481122300000X
OH30020255122300000X
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4347413Medicaid