Provider Demographics
NPI:1366571747
Name:DOLBERG, BRIAN S (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:DOLBERG
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 1:4390 N MILLER RD
Mailing Address - Street 2:#106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3613
Mailing Address - Country:US
Mailing Address - Phone:480-949-5858
Mailing Address - Fax:480-949-5922
Practice Address - Street 1:4390 N MILLER RD
Practice Address - Street 2:#106
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3613
Practice Address - Country:US
Practice Address - Phone:480-949-5858
Practice Address - Fax:480-949-5922
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice