# NEIBAUER DENTAL CARE, PC

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

## Provider details

- **NPI number:** 1922375542
- **Legal business name:** NEIBAUER DENTAL CARE, PC
- **Authorized official:** KIM WILSON (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-5100

## Contact information

- **Practice address:** 3950 FETTLER PARK DR, DUMFRIES, VA 22025-1997
- **Practice address phone:** (703) 221-3295
- **Practice address fax:** (703) 221-3492
- **Mailing address:** 3950 FETTLER PARK DR, DUMFRIES, VA 22025-1997
- **Mailing address phone:** (703) 221-3295
- **Mailing address fax:** (703) 221-3492

## 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