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General NPI Number Information
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NPI Number | 1003091752
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Entity Type | Organization
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Legal Business Name | SAMUEL V MESAROS PC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 115 COTTONWOOD LANE
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City | DANVILLE
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State | VA
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Zip | 24540
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Country | US
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Telephone | 434-791-4700
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Fax | 434-791-3740
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Provider Business Mailing Address
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Address Line | 115 COTTONWOOD LANE
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City | DANVILLE
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State | VA
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Zip | 24540
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Country | US
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Telephone | 434-791-4700
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Fax | 434-791-3740
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL V MESAROS
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Credential | DDS MS
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Telephone | 434-791-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401008440
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License Number State | VA
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