# NEIBAUER DENTAL CARE, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NEIBAUER DENTAL CARE, PC
- **Other names:** Neibauer Dental Care - Manassas
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1295002814
- **Legal business name:** NEIBAUER DENTAL CARE, PC
- **Authorized official:** KIM WILSON (CREDENTIALING COORD.)
- **Authorized official phone:** (217) 540-5100

## Contact information

- **Practice address:** 10051 MARKET CIR, MANASSAS, VA 20110-2120
- **Practice address phone:** (571) 921-9103
- **Practice address fax:** (703) 335-5161
- **Mailing address:** 10051 MARKET CIR, MANASSAS, VA 20110-2120
- **Mailing address phone:** (571) 921-9103
- **Mailing address fax:** (703) 335-5161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/28/2011
- **Last updated:** 11/28/2011