Tracey B David, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11927 Issued in FL

Practice address

120 9TH Ave N
Jacksonville Beach, FL 32250-7141

Phone

(904) 246-7554

Fax

(904) 249-1842

NPI assigned

Nov 13, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 19, 2021 through Jan 19, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Roy F. and Tracey B. David, DMD PA

  • General Practice Dentistry
  • Jacksonville Beach, FL
  • NPI 1104971159
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538230321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 9TH AVE N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322507141",
            "telephone_number": "904-246-7554",
            "fax_number": "904-249-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 9TH AVE N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322507141",
            "telephone_number": "904-246-7554",
            "fax_number": "904-249-1842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVID",
        "first_name": "TRACEY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "11927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Davenport Chiropractic, P.a.
• David C Blackmon,PHD,Psych SVC
• Agnes G. David, M. D.
• Roy F David, DMD
• Sarah Kathryn David
• Brooke Worthington Davidson, AU.D.
• Robert Davies, MD
• Melissa Dawson
• Virginia Dawson, M.D.
• De-Senesce LLC

• General Practice Dentistry in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.