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General NPI Number Information
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NPI Number | 1023385648
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Entity Type | Organization
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Legal Business Name | NEIBAUER DENTAL CARE, PC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 14901 POTOMAC TOWN PL SUITE 175
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City | WOODBRIDGE
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State | VA
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Zip | 22191-4096
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Country | US
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Telephone | 703-580-5515
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Fax | 703-583-1487
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Provider Business Mailing Address
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Address Line | 14901 POTOMAC TOWN PL SUITE 175
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City | WOODBRIDGE
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State | VA
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Zip | 22191-4096
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Country | US
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Telephone | 703-580-5515
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Fax | 703-583-1487
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Authorized Official
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Title or Position | CREDENTIALING COORD.
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Name | KIM WILSON
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Credential |
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Telephone | 217-540-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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