Provider Demographics
NPI:1598811754
Name:SAMUEL B. GASKINS IV DMD PA
Entity Type:Organization
Organization Name:SAMUEL B. GASKINS IV DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:BELTON
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-744-4522
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11982261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental