Provider Demographics
NPI:1952678690
Name:NEIBAUER DENTAL CARE, PC
Entity Type:Organization
Organization Name:NEIBAUER DENTAL CARE, PC
Other - Org Name:GREAT MILLS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:22329 GREENVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:GREAT MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20634-4424
Mailing Address - Country:US
Mailing Address - Phone:301-862-2044
Mailing Address - Fax:301-862-5188
Practice Address - Street 1:22329 GREENVIEW PKWY
Practice Address - Street 2:
Practice Address - City:GREAT MILLS
Practice Address - State:MD
Practice Address - Zip Code:20634-4424
Practice Address - Country:US
Practice Address - Phone:301-862-2044
Practice Address - Fax:301-862-5188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEIBAUER DENTAL CARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-23
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty