=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629109640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JERRY L. POSENAU, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7575 COLD HARBOR RD SUITE 1-C
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23111-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-730-1424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7575 COLD HARBOR RD SUITE 1-C
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23111-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-730-1424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JERRY LEE POSENAU
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 804-730-1424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401005513
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------