BLUE RIDGE ORAL SURGERY INC. NPI 1710013446

NPI Information

  • NPI: 1710013446
  • Provider Name: BLUE RIDGE ORAL SURGERY, INC.
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • Doing Business As: BLUE RIDGE ORAL & MAXILLOFACIAL SURGERY
  • Address: 54 S. MEDICAL PARK DRIVE
    FISHERSVILLE, VA
    ZIP 22939
  • Phone: (540) 886-2956

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NPI Details

BLUE RIDGE ORAL SURGERY, INC. is an oral and maxillofacial surgery dentist in Fishersville, VA. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. BLUE RIDGE ORAL SURGERY, INC. NPI is 1710013446. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Blue Ridge Oral & Maxillofacial Surgery.

The provider's business location address is:

54 S. MEDICAL PARK DRIVE
FISHERSVILLE, VA
ZIP 22939-333
Phone: (540) 886-2956
Fax: (540) 886-2284

The provider's authorized official is Matthew Todd Brandt .
The authorized official title is President and has the following contact phone number (540) 886-2956.

The enumeration date for this NPI number is 2/26/2007 and was last updated on 7/10/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery0438000074VIRGINIANo
21223S0112XDentistOral and Maxillofacial Surgery0401410707VIRGINIANo
31223S0112XDentistOral and Maxillofacial Surgery0438000220VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
19198564MEDICAIDVIRGINIA
211605304OTHERCAQH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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