Healthcare Provider Details

I. General information

NPI: 1689011009
Provider Name (Legal Business Name): GEOFFREY MORGAN SCHREIBER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6033 PROVIDENCE RD
VIRGINIA BEACH VA
23464
US

IV. Provider business mailing address

6033 PROVIDENCE RD
VIRGINIA BEACH VA
23464-3815
US

V. Phone/Fax

Practice location:
  • Phone: 757-424-2672
  • Fax: 757-424-2672
Mailing address:
  • Phone: 757-424-2672
  • Fax: 757-424-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414078
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number043800380
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: