Provider Demographics
NPI:1497745749
Name:NEUBAUER, EDWARD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:NEUBAUER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:530 N TELSHOR BLVD
Mailing Address - Street 2:SUITEA
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8243
Mailing Address - Country:US
Mailing Address - Phone:505-532-5437
Mailing Address - Fax:505-522-4138
Practice Address - Street 1:506 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2602
Practice Address - Country:US
Practice Address - Phone:505-325-7700
Practice Address - Fax:505-327-5710
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD17801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice