# SAMUEL V MESAROS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003091752
- **Authorized official:** DR. SAMUEL V MESAROS DDS MS (PRESIDENT)
- **Authorized official phone:** (434) 791-4700

## Contact information

- **Practice address:** 115 COTTONWOOD LANE, DANVILLE, VA 24540
- **Practice address phone:** (434) 791-4700
- **Practice address fax:** (434) 791-3740
- **Mailing address:** 115 COTTONWOOD LANE, DANVILLE, VA 24540
- **Mailing address phone:** (434) 791-4700
- **Mailing address fax:** (434) 791-3740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 0401008440 | VA | Yes |

## Other

- **Enumeration date:** 12/31/2007
- **Last updated:** 12/31/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 115194 | ANTHEM | VA |
| 01 | — | 8440 | DELTA | VA |