Individual provider Active NPI

David Fine, D.D.S.

  • General Practice Dentistry
  • Lake Worth, FL
National Provider Identifier
1487656526
Registry record updated Jun 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN17422 Issued in FL
Practice address
7378 Lake Worth Road
Lake Worth, FL 33467
Phone
(561) 968-7050
Fax
(561) 968-7068
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN17422 FL Primary
General Practice Dentistry 1223G0001X 035120 NY

Addresses

Primary practice location

7378 Lake Worth Road
Lake Worth, FL 33467

Mailing address

7378 Lake Worth Road
Lake Worth, FL 33467
Phone (561) 968-7050

Other identifiers 1

IdentifierTypeStateIssuer
00483005MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150713000046 FL Order and Referring Only - DentistPractitioner - Dentist 9931411485

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN17422FLMDGeneral Practice Dentistry
035120NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jacqueline Molina Wasserman P.a. General Practice Past Accepting new patients
TTB Dentistry General Practice PastSince Oct 1, 2022 Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434499200000",
    "number": "1487656526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7378 LAKE WORTH ROAD",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "33467",
            "telephone_number": "561-968-7050",
            "fax_number": "561-968-7068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7378 LAKE WORTH ROAD",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "33467",
            "telephone_number": "561-968-7050",
            "fax_number": "561-968-7068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FINE",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2015-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN17422",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "035120",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00483005",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Worth, FL

Sources for this page

Verify at the official NPI Registry.