Provider Demographics
NPI:1740323930
Name:HIMMELBERG, DOUGLAS LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LYNN
Last Name:HIMMELBERG
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 1:33821 BLUE LANTERN ST
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:949-240-1486
Mailing Address - Fax:949-240-1486
Practice Address - Street 1:2750 YNEZ RD
Practice Address - Street 2:STE 106
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-693-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics