Organization
NEIBAUER DENTAL CARE, P.C.
Active
Parent organization
NEIBAUER DENTAL CARE, PC
Other names
Lifetime Dentistry at Short Pump
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEIBAUER DENTAL CARE, PC
Authorized official
ALL CREDENTIALING (CREDENTIALING COORDINATOR)
(217) 540-2100
Entity
Organization
Contact information
Practice address
12244 W BROAD ST, HENRICO, VA 23233-1062
(804) 360-8890
(804) 360-8894
Mailing address
12244 W BROAD ST, HENRICO, VA 23233-1062
(804) 360-8890
(804) 360-8894
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401412223
VA
122300000X
Dentist
Primary
0401413582
VA
1223G0001X
General Practice Dentistry
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Other
Enumeration date
11/28/2011
Last updated
10/28/2022
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