Active NPI
Justin Christopher Neibauer, D.D.S.
- General Practice Dentistry
- Fredericksburg, VA
National Provider Identifier
1609957166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 0401411419
- Practice address
- 10039 Jefferson Davis Hwy
Fredericksburg, VA 22407-9418 - Phone
- (540) 898-8998
- Fax
- (540) 898-8863
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401411419 | VA | Primary |
Addresses
Primary practice location
10039 Jefferson Davis Hwy
Fredericksburg, VA 22407-9418
Mailing address
10039 Jefferson Davis Hwy
Fredericksburg, VA 22407-9418
Phone (540) 898-8998
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160615001859 | VA | Order and Referring Only - Dentist | 1850682204 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401411419 | VA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471910400000",
"number": "1609957166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10039 JEFFERSON DAVIS HWY",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224079418",
"telephone_number": "540-898-8998",
"fax_number": "540-898-8863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10039 JEFFERSON DAVIS HWY",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224079418",
"telephone_number": "540-898-8998",
"fax_number": "540-898-8863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEIBAUER",
"first_name": "JUSTIN",
"middle_name": "CHRISTOPHER",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2016-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "0401411419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.