Healthcare Provider Details

I. General information

NPI: 1740323930
Provider Name (Legal Business Name): DOUGLAS LYNN HIMMELBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 YNEZ RD STE 106
TEMECULA CA
92591
US

IV. Provider business mailing address

33821 BLUE LANTERN ST
DANA POINT CA
92629
US

V. Phone/Fax

Practice location:
  • Phone: 951-693-9373
  • Fax:
Mailing address:
  • Phone: 949-240-1486
  • Fax: 949-240-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number29061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: