Provider Demographics
NPI:1184718157
Name:NIEBERGALL, DAVID C (DDS INC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:NIEBERGALL
Suffix:
Gender:M
Credentials:DDS INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29350 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:310-457-9292
Mailing Address - Fax:310-457-4923
Practice Address - Street 1:29350 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265
Practice Address - Country:US
Practice Address - Phone:310-457-9292
Practice Address - Fax:310-457-4923
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist