Healthcare Provider Details

I. General information

NPI: 1053723700
Provider Name (Legal Business Name): DAVID HAMILTON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 E 3500 N STE 102
LEHI UT
84043-3847
US

IV. Provider business mailing address

149 TUSCAN WAY
ST. AUGUSTINE FL
32092
US

V. Phone/Fax

Practice location:
  • Phone: 385-510-3496
  • Fax: 385-510-3497
Mailing address:
  • Phone: 904-201-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13770532-9926
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN20801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: