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General NPI Number Information
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NPI Number | 1376953901
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Entity Type | Organization
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Legal Business Name | SAMUEL BLACK, DMD, PHD, PC
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 3700 OLD FOREST RD.
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City | LYNCHBURG
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State | VA
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Zip | 24501
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Country | US
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Telephone | 434-515-0370
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Fax | 434-338-6552
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Provider Business Mailing Address
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Address Line | 3700 OLD FOREST RD.
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City | LYNCHBURG
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State | VA
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Zip | 24501
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Country | US
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Telephone | 434-515-0370
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Fax | 434-338-6552
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL ARTHUR BLACK JR.
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Credential | M.S., D.M.D., PH.D.
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Telephone | 617-875-3293
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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 | 0401412426
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License Number State | VA
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