Active NPI
Amelia David, DDS
- Periodontics
- San Bernardino, CA
National Provider Identifier
1811580004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DDS1117738
- Practice address
- 159 W Hospitality LN
San Bernardino, CA 92408-3348 - Phone
- (909) 558-4960
- NPI assigned
- Feb 18, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DE61449145 | WA | |
| Periodontics | 1223P0300X | 294 | CA | |
| Periodontics | 1223P0300X | DDS1117738 | CA | Primary |
Addresses
Primary practice location
159 W Hospitality LN
San Bernardino, CA 92408-3348
Mailing address
11092 Anderson St Dept of
Loma Linda, CA 92350-1706
Electronic endpoints 5
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | amdavid@llu.edu | LLU FACULTY DENTAL OFFICE | |
| CONNECT URL | amdavid@llu.edu | ||
| CONNECT URL | amdavid@llu.edu | ||
| CONNECT URL | amdavid@llu.edu | ||
| CONNECT URL | amdavid@llu.edu |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240131001415 | WA | Order and Referring Only - Dentist | 9931552551 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS1117738 | CA | MD | Periodontist |
| 294 | CA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752537600000",
"number": "1811580004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11092 ANDERSON ST DEPT OF",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923501706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 W HOSPITALITY LN",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924083348",
"telephone_number": "909-558-4960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVID",
"first_name": "AMELIA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-18",
"last_updated": "2025-07-15",
"certification_date": "2025-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WA",
"license": "DE61449145",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "294",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "DDS1117738",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "amdavid@llu.edu",
"affiliation": "Y",
"endpointDescription": "work email",
"affiliationName": "LLU FACULTY DENTAL OFFICE",
"address_1": "159 W Hospitality Ln",
"city": "San Bernardino",
"state": "CA",
"country_code": "US",
"postal_code": "924083346",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "amdavid@llu.edu",
"affiliation": "N",
"endpointDescription": "work email",
"address_1": "159 W Hospitality Ln",
"city": "San Bernardino",
"state": "CA",
"country_code": "US",
"postal_code": "924083346",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "amdavid@llu.edu",
"affiliation": "N",
"endpointDescription": "work email",
"address_1": "159 W Hospitality Ln",
"city": "San Bernardino",
"state": "CA",
"country_code": "US",
"postal_code": "924083346",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "amdavid@llu.edu",
"affiliation": "N",
"endpointDescription": "work email",
"address_1": "159 W Hospitality Ln",
"city": "San Bernardino",
"state": "CA",
"country_code": "US",
"postal_code": "924083346",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "amdavid@llu.edu",
"affiliation": "N",
"endpointDescription": "work email",
"address_1": "159 W Hospitality Ln",
"city": "San Bernardino",
"state": "CA",
"country_code": "US",
"postal_code": "924083346",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in San Bernardino, CA
- David J. Jo DDS, Ms Inc.
- David Kutner a Dental Corp (american family dental)
- David Trung D. Nguyen, M.D., Inc.
- David W. Yang, a Professional Corporation
- David Westerberg D.D.S. Corporation
- Kasey David
- Cherilyn Elaine Davidson Cibelli, PH.D.
- Jamie Davidson
- Robert Flores Davila, RN
- Agnes Serafina Davis
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.