NPIMap

Organization Active NPI

Neibauer Dental Care, P.C.

Doing business as Lifetime Dentistry at Short Pump

  • Dentist
  • Henrico, VA
National Provider Identifier
1396012936
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401413582 Issued in VA
Legal business name
NEIBAUER DENTAL CARE, P.C.
Doing business as
Lifetime Dentistry at Short Pump
Practice address
12244 W Broad St
Henrico, VA 23233-1062
Phone
(804) 360-8890
Fax
(804) 360-8894
NPI assigned
Nov 28, 2011
Last updated
Oct 28, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
NEIBAUER DENTAL CARE, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

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

Authorized official

Name
All Credentialing
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401412223 VA
Dentist 122300000X 0401413582 VA Primary
General Practice Dentistry 1223G0001X

Addresses

Primary practice location

12244 W Broad St
Henrico, VA 23233-1062

Mailing address

12244 W Broad St
Henrico, VA 23233-1062
Phone (804) 360-8890

Other names 1

  • Lifetime Dentistry at Short Pump 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

12246 W Broad St
Henrico, VA 23233

11736 W Broad St
Ste 112
Richmond, VA 23233
Phone (804) 360-8890

12244 W Broad St
Richmond, VA 23233
Phone (804) 360-8890

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 6

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": "1666915200000",
    "number": "1396012936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12244 W BROAD ST",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232331062",
            "telephone_number": "804-360-8890",
            "fax_number": "804-360-8894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12244 W BROAD ST",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232331062",
            "telephone_number": "804-360-8890",
            "fax_number": "804-360-8894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIBAUER DENTAL CARE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEIBAUER DENTAL CARE, PC",
        "enumeration_date": "2011-11-28",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A",
        "authorized_official_last_name": "CREDENTIALING",
        "authorized_official_first_name": "ALL",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401412223",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401413582",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifetime Dentistry at Short Pump",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lifetime Dentistry at Short Pump",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henrico, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.