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General NPI Number Information
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NPI Number | 1346580974
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Entity Type | Individual
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Provider Name | NICHOLAS PETER THEBERGE DDS
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Gender | Male
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 285 HIGH ST
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City | GREENFIELD
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State | MA
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Zip | 01301-2608
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Country | US
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Telephone | 413-774-2961
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Fax | 413-773-3076
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Provider Business Mailing Address
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Address Line | 44 WHITE BIRCH DR
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City | CHESTERFIELD
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State | NH
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Zip | 03443-3622
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Country | US
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Telephone | 603-903-3058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DN1857508
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License Number State | MA
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