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General NPI Number Information
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NPI Number | 1649555681
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Entity Type | Organization
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Legal Business Name | SAMUEL R LASRIS DDS
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 395 S MAIN ST
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City | DANVILLE
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State | VA
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Zip | 24541-2925
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Country | US
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Telephone | 434-797-2357
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Fax | 434-797-3596
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Provider Business Mailing Address
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Address Line | 395 SOUTH MAIN STREET
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City | DANVILLE
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State | VA
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Zip | 24541
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Country | US
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Telephone | 434-797-2357
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Fax | 434-797-3596
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Authorized Official
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Title or Position | OFFICE RECEPTIONIST
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Name | MRS. VICKI B HARRELSON
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Credential |
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Telephone | 434-707-2357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401412538
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License Number State | VA
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