Provider Demographics
NPI:1629109640
Name:JERRY L. POSENAU, DDS, PC
Entity Type:Organization
Organization Name:JERRY L. POSENAU, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:POSENAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-730-1424
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty