# BLUE RIDGE ORAL SURGERY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blue Ridge Oral & Maxillofacial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710013446
- **Authorized official:** MATTHEW TODD BRANDT D.D.S., M.D. (PRESIDENT)
- **Authorized official phone:** (540) 886-2956

## Contact information

- **Practice address:** 54 S. MEDICAL PARK DRIVE, FISHERSVILLE, VA 22939-2333
- **Practice address phone:** (540) 886-2956
- **Practice address fax:** (540) 886-2284
- **Mailing address:** 54 S. MEDICAL PARK DRIVE, FISHERSVILLE, VA 22939-2333
- **Mailing address phone:** (540) 886-2956
- **Mailing address fax:** (540) 886-2284

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0401410707 | VA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0438000074 | VA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0438000220 | VA | Yes |

## Other

- **Enumeration date:** 02/26/2007
- **Last updated:** 07/10/2013