Healthcare Provider Details

I. General information

NPI: 1992087555
Provider Name (Legal Business Name): BRANDON L. GEDDES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 ADMIRAL TAUSSIG BLVD
NORFOLK VA
23511
US

IV. Provider business mailing address

1313 STAMFORD DR
VIRGINIA BEACH VA
23455-9242
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-8500
  • Fax:
Mailing address:
  • Phone: 317-219-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413538
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12011672A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413538
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: