Provider Demographics
NPI:1588790570
Name:NEIBAUER, CHRIS (DDS)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:NEIBAUER
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 1:117 SAINT PATRICKS DR
Mailing Address - Street 2:117 SAINT PATRICKS DRIVE
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4574
Mailing Address - Country:US
Mailing Address - Phone:301-870-4553
Mailing Address - Fax:
Practice Address - Street 1:117 SAINT PATRICKS DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4574
Practice Address - Country:US
Practice Address - Phone:301-870-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist