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	:	1942577580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIBAUER DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	20 BERKSHIRE DR STE 115
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7863
Country	:	US
Telephone Number	:	540-720-7720
Fax Number	:	540-720-7728

Provider Business Practice Location Address
First Line	:	20 BERKSHIRE DR STE 115
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7863
Country	:	US
Telephone Number	:	540-720-7720
Fax Number	:	540-720-7728

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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