Provider Demographics
NPI:1467763375
Name:NEIBAUR, CHAD BRIGG (DMD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:BRIGG
Last Name:NEIBAUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5003
Mailing Address - Country:US
Mailing Address - Phone:907-456-6111
Mailing Address - Fax:907-451-6122
Practice Address - Street 1:102 10TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5003
Practice Address - Country:US
Practice Address - Phone:907-456-6111
Practice Address - Fax:907-451-6122
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist