Provider Demographics
NPI:1295736627
Name:NEUBAUER, BRENT EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:EDWARD
Last Name:NEUBAUER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 MOBILE ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7907
Mailing Address - Country:US
Mailing Address - Phone:757-430-0654
Mailing Address - Fax:
Practice Address - Street 1:NAS JACKSONVILLE BUILDING 554
Practice Address - Street 2:BUREAU OF MEDICINE & SURGERY DETACHMENT JACKSONVILL
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:877-772-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH194901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice