Provider Demographics
NPI:1245014638
Name:POSZE, SAMUEL BENJAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BENJAMIN
Last Name:POSZE
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 1:11528 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7237
Mailing Address - Country:US
Mailing Address - Phone:225-236-8926
Mailing Address - Fax:
Practice Address - Street 1:699 QUEENS HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4902
Practice Address - Country:US
Practice Address - Phone:225-236-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist