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General NPI Number Information
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NPI Number | 1053171462
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Entity Type | Organization
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Legal Business Name | RADIANT FLUX PLLC
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 700 INDEPENDENCE CIR STE 3B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6405
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Country | US
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Telephone | 757-929-7100
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Fax | 757-929-7097
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Provider Business Mailing Address
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Address Line | 1301 BRIDGEPORT WAY SUITE 109
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City | SUFFOLK
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State | VA
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Zip | 23435
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Country | US
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Telephone | 757-484-1444
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Fax | 757-484-3712
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN GENE BRIESEMEISTER
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Credential | DDS
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Telephone | 757-929-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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