Healthcare Provider Details

I. General information

NPI: 1346580974
Provider Name (Legal Business Name): NICHOLAS PETER THEBERGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 HIGH ST
GREENFIELD MA
01301-2608
US

IV. Provider business mailing address

44 WHITE BIRCH DR
CHESTERFIELD NH
03443-3622
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-2961
  • Fax: 413-773-3076
Mailing address:
  • Phone: 603-903-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN1857508
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: