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General NPI Number Information
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NPI Number | 1598811754
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Entity Type | Organization
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Legal Business Name | SAMUEL B. GASKINS IV DMD PA
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Dates
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Enumeration Date | 01/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 943 CESERY BLVD BUILDING B
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City | JACKSONVILLE
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State | FL
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Zip | 32211-5635
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Country | US
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Telephone | 904-744-4522
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Fax | 904-744-2692
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Provider Business Mailing Address
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Address Line | 943 CESERY BLVD BUILDING B
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City | JACKSONVILLE
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State | FL
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Zip | 32211-5635
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Country | US
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Telephone | 904-744-4522
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Fax | 904-744-2692
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL BELTON GASKINS IV
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Credential | DMD
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Telephone | 904-744-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 11982
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License Number State | FL
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