=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053723700
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID HAMILTON DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2014
-----------------------------------------------------
Last Update Date | 08/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 TUSCAN WAY
-----------------------------------------------------
City | ST. AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-201-3205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 149 TUSCAN WAY
-----------------------------------------------------
City | ST. AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-201-3205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN20801
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------