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General NPI Number Information
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NPI Number | 1104971159
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Entity Type | Organization
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Legal Business Name | ROY F. AND TRACEY B. DAVID, DMD PA
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 120 9TH AVE N
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-7141
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Country | US
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Telephone | 904-246-7554
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Fax | 904-249-1842
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Provider Business Mailing Address
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Address Line | 120 9TH AVE N
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-7141
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Country | US
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Telephone | 904-246-7554
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Fax | 904-249-1842
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROY F DAVID
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Credential | DMD
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Telephone | 904-246-7554
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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 | 11956
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License Number State | FL
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