Organization
NEIBAUER DENTAL CARE, PC
Active
Parent organization
NEIBAUER DENTAL CARE, PC
Other names
Neibauer Dental Care - Woodbridge
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEIBAUER DENTAL CARE, PC
Authorized official
KIM WILSON (CREDENTIALING COORD.)
(217) 540-5100
Entity
Organization
Contact information
Practice address
14901 POTOMAC TOWN PL, SUITE 175, WOODBRIDGE, VA 22191-4096
(703) 580-5515
(703) 583-1487
Mailing address
14901 POTOMAC TOWN PL, SUITE 175, WOODBRIDGE, VA 22191-4096
(703) 580-5515
(703) 583-1487
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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