Provider Demographics
NPI:1053171462
Name:RADIANT FLUX PLLC
Entity type:Organization
Organization Name:RADIANT FLUX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BRIESEMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-929-7100
Mailing Address - Street 1:1301 BRIDGEPORT WAY SUITE 109
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:757-484-1444
Mailing Address - Fax:757-484-3712
Practice Address - Street 1:700 INDEPENDENCE CIR STE 3B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6405
Practice Address - Country:US
Practice Address - Phone:757-929-7100
Practice Address - Fax:757-929-7097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIANT FLUX PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment