Provider Demographics
NPI:1548537186
Name:NEIBAUER DENTAL CARE, PC
Entity type:Organization
Organization Name:NEIBAUER DENTAL CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5141
Mailing Address - Street 1:13334 MINNIEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4033
Mailing Address - Country:US
Mailing Address - Phone:703-910-3285
Mailing Address - Fax:703-670-0351
Practice Address - Street 1:13334 MINNIEVILLE RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4033
Practice Address - Country:US
Practice Address - Phone:703-910-3285
Practice Address - Fax:703-670-0351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEIBAUER DENTAL CARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty