Healthcare Provider Details

I. General information

NPI: 1902698764
Provider Name (Legal Business Name): SARAH DAVIS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DOLPHIN DR
ST AUGUSTINE FL
32080-4531
US

IV. Provider business mailing address

1651 EVANS DR S # A
JACKSONVILLE BEACH FL
32250-2585
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-8652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: