# NEIBAUER DENTAL CARE, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NEIBAUER DENTAL CARE, PC
- **Other names:** Lifetime Dentistry at Short Pump
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396012936
- **Legal business name:** NEIBAUER DENTAL CARE, PC
- **Authorized official:** ALL CREDENTIALING (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-2100

## Contact information

- **Practice address:** 12244 W BROAD ST, HENRICO, VA 23233-1062
- **Practice address phone:** (804) 360-8890
- **Practice address fax:** (804) 360-8894
- **Mailing address:** 12244 W BROAD ST, HENRICO, VA 23233-1062
- **Mailing address phone:** (804) 360-8890
- **Mailing address fax:** (804) 360-8894

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401412223 | VA | — |
| 122300000X | Dentist | 0401413582 | VA | Yes |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |

## Other

- **Enumeration date:** 11/28/2011
- **Last updated:** 10/28/2022