Provider Demographics
NPI:1740384825
Name:MERRY-NIEBRUGGE, MARGARET JANE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:JANE
Last Name:MERRY-NIEBRUGGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S THIRD ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-3632
Mailing Address - Country:US
Mailing Address - Phone:217-347-5076
Mailing Address - Fax:217-347-5080
Practice Address - Street 1:107 S THIRD ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3632
Practice Address - Country:US
Practice Address - Phone:217-347-5076
Practice Address - Fax:217-347-5080
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist