MEDICARE: NEIBAUER DENTAL CARE, PC

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

General Provider Information

NPI Number	:	1265709802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIBAUER DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	8626 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-4205
Country	:	US
Telephone Number	:	703-554-3500
Fax Number	:	703-360-3453

Provider Business Practice Location Address
First Line	:	8626 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-4205
Country	:	US
Telephone Number	:	703-554-3500
Fax Number	:	703-360-3453

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	KAM SHICK
Credential	:
Telephone Number	:	217-540-5141

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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