Healthcare Provider Details

I. General information

NPI: 1053406967
Provider Name (Legal Business Name): ALBERTO G DAVID D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 OLD MOULTRIE RD
ST AUGUSTINE FL
32086-5164
US

IV. Provider business mailing address

1971 OLD MOULTRIE RD
ST AUGUSTINE FL
32086-5164
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-5111
  • Fax: 904-824-7894
Mailing address:
  • Phone: 904-829-5111
  • Fax: 904-824-7894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN0011238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: