Provider Demographics
NPI:1245587609
Name:GASKINS, SAMUEL BELTON IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BELTON
Last Name:GASKINS
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 CESERY BLVD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5635
Mailing Address - Country:US
Mailing Address - Phone:904-744-4522
Mailing Address - Fax:904-744-2692
Practice Address - Street 1:943 CESERY BLVD
Practice Address - Street 2:BUILDING B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5635
Practice Address - Country:US
Practice Address - Phone:904-744-4522
Practice Address - Fax:904-744-2692
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN119821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice