Healthcare Provider Details

I. General information

NPI: 1902160849
Provider Name (Legal Business Name): DANIEL LEE MESSERSCHMIDT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANIEL LEE MESSERSCHMIDT DDS

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 FALLS RD
VICTORIRA VA
23974
US

IV. Provider business mailing address

1870 PRICE DR
FARMVILLE VA
23970
US

V. Phone/Fax

Practice location:
  • Phone: 434-696-2045
  • Fax:
Mailing address:
  • Phone: 434-390-0490
  • Fax: 434-696-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401006805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: