MEDICARE: DR. MICHAEL D AMODIO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4465	CT

General Provider Information

NPI Number	:	1235134537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D AMODIO DDS

Provider Business Mailing Address
First Line	:	204 QUINNIPIAC AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3626
Country	:	US
Telephone Number	:	203-865-4667
Fax Number	:	203-787-2944

Provider Business Practice Location Address
First Line	:	204 QUINNIPIAC AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3626
Country	:	US
Telephone Number	:	203-865-4667
Fax Number	:	203-787-2944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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