Active NPI
Ben Neibaur, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Draper, UT
National Provider Identifier
1417004227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 4990210-9921
- Practice address
- 155 E 13800 S
Suite F4
Draper, UT 84020-9806 - Phone
- (801) 269-0303
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 8591 | TN | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 4990210-9921 | UT | Primary |
Addresses
Primary practice location
155 E 13800 S
Suite F4
Draper, UT 84020-9806
Mailing address
155 E 13800 S
Suite F4
Draper, UT 84020-9806
Phone (801) 269-0303
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4990210-9921 | UT | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403740800000",
"number": "1417004227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 E 13800 S",
"address_2": "SUITE F4",
"city": "DRAPER",
"state": "UT",
"postal_code": "840209806",
"telephone_number": "801-269-0303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 E 13800 S",
"address_2": "SUITE F4",
"city": "DRAPER",
"state": "UT",
"postal_code": "840209806",
"telephone_number": "801-269-0303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEIBAUR",
"first_name": "BEN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2014-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TN",
"license": "8591",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "UT",
"license": "4990210-9921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.