Organization
BLUE RIDGE ORAL SURGERY, INC.
Active
Other names
Blue Ridge Oral & Maxillofacial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW TODD BRANDT D.D.S., M.D. (PRESIDENT)
(540) 886-2956
Entity
Organization
Contact information
Practice address
54 S. MEDICAL PARK DRIVE, FISHERSVILLE, VA 22939-2333
(540) 886-2956
(540) 886-2284
Mailing address
54 S. MEDICAL PARK DRIVE, FISHERSVILLE, VA 22939-2333
(540) 886-2956
(540) 886-2284
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401410707
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0438000074
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0438000220
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11605304
CAQH
—
05
—
9198564
—
VA
Enumeration date
02/26/2007
Last updated
07/10/2013
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