Provider Demographics
NPI:1548391550
Name:POSENAU, JERRY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEE
Last Name:POSENAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 COLD HARBOR RD
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1600
Mailing Address - Country:US
Mailing Address - Phone:804-730-1424
Mailing Address - Fax:
Practice Address - Street 1:7575 COLD HARBOR RD
Practice Address - Street 2:SUITE 1-C
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1600
Practice Address - Country:US
Practice Address - Phone:804-730-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist