MEDICARE: DR. DOUGLAS RILEY BERT MARBERGER D,D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1299039922	UT

General Provider Information

NPI Number	:	1053327965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS RILEY BERT MARBERGER D,D.S.

Provider Business Mailing Address
First Line	:	166EAST4600SOUTH
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-5946
Country	:	US
Telephone Number	:	801-392-4940
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 E 4600 S
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-5946
Country	:	US
Telephone Number	:	801-392-4940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/04/2009

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