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General NPI Number Information
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NPI Number | 1053406967
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Entity Type | Individual
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Provider Name | ALBERTO G DAVID D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1971 OLD MOULTRIE RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5164
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Country | US
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Telephone | 904-829-5111
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Fax | 904-824-7894
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Provider Business Mailing Address
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Address Line | 1971 OLD MOULTRIE RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5164
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Country | US
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Telephone | 904-829-5111
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Fax | 904-824-7894
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN0011238
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License Number State | FL
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