# SAMUEL BLACK, DMD, PHD, PC

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

## Provider details

- **NPI number:** 1376953901
- **Authorized official:** DR. SAMUEL ARTHUR BLACK JR. M.S., D.M.D., PH.D. (PRESIDENT)
- **Authorized official phone:** (617) 875-3293

## Contact information

- **Practice address:** 3700 OLD FOREST RD., LYNCHBURG, VA 24501
- **Practice address phone:** (434) 515-0370
- **Practice address fax:** (434) 338-6552
- **Mailing address:** 3700 OLD FOREST RD., LYNCHBURG, VA 24501
- **Mailing address phone:** (434) 515-0370
- **Mailing address fax:** (434) 338-6552

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 0401412426 | VA | Yes |

## Other

- **Enumeration date:** 05/05/2014
- **Last updated:** 05/05/2014