Healthcare Provider Details

I. General information

NPI: 1134597644
Provider Name (Legal Business Name): BRANDON MEYER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N LIGHT ST
LOVETTSVILLE VA
20180-8613
US

IV. Provider business mailing address

2 N LIGHT ST
LOVETTSVILLE VA
20180-8613
US

V. Phone/Fax

Practice location:
  • Phone: 540-822-4224
  • Fax: 540-822-5115
Mailing address:
  • Phone: 540-822-4224
  • Fax: 540-822-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415012
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: