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General NPI Number Information
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NPI Number | 1215204839
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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 | 08/28/2015
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Provider Practice Location Address
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Address Line | 251 WEST LEE HWY. SUITE 197
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City | WARRENTON
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State | VA
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Zip | 20186-2047
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Country | US
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Telephone | 540-347-9364
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Fax | 540-341-0183
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Provider Business Mailing Address
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Address Line | 251 WEST LEE HWY. SUITE 197
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City | WARRENTON
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State | VA
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Zip | 20186-2047
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Country | US
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Telephone | 540-347-9364
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Fax | 540-341-0183
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | KENDRA WALKER
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Credential |
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Telephone | 217-540-8312
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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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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401414394
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License Number State | VA
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