NPIMap

Organization Active NPI

Neibauer Dental Care, PC

Doing business as Neibauer Dental Care - Woodbridge

  • General Practice Dentistry
  • Woodbridge, VA
National Provider Identifier
1023385648
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NEIBAUER DENTAL CARE, PC
Doing business as
Neibauer Dental Care - Woodbridge
Practice address
14901 Potomac Town PL
Suite 175
Woodbridge, VA 22191-4096
Phone
(703) 580-5515
Fax
(703) 583-1487
NPI assigned
Nov 28, 2011
Last updated
Nov 28, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
NEIBAUER DENTAL CARE, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kim Wilson
Title
Credentialing Coord.
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

14901 Potomac Town PL
Suite 175
Woodbridge, VA 22191-4096

Mailing address

14901 Potomac Town PL
Suite 175
Woodbridge, VA 22191-4096
Phone (703) 580-5515

Other names 1

  • Neibauer Dental Care - Woodbridge Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Neibauer Dental Care PC30 organizations share this tax ID, including this one
Part of
Neibauer Dental Care PC

Other organizations with this tax ID 29

Organizations that report the same tax identification number in the National Provider Directory.

View all 29

Locations

14901 Potomac Town Pl
Ste 175
Woodbridge, VA 22191
Phone (703) 580-5515

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1023385648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14901 POTOMAC TOWN PL",
            "address_2": "SUITE 175",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221914096",
            "telephone_number": "703-580-5515",
            "fax_number": "703-583-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14901 POTOMAC TOWN PL",
            "address_2": "SUITE 175",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221914096",
            "telephone_number": "703-580-5515",
            "fax_number": "703-583-1487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIBAUER DENTAL CARE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEIBAUER DENTAL CARE, PC",
        "enumeration_date": "2011-11-28",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CREDENTIALING COORD.",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neibauer Dental Care - Woodbridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.