Healthcare Provider Details

I. General information

NPI: 1972948198
Provider Name (Legal Business Name): MICHAEL DAVID D'AMICO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD STE 1115
NEWARK DE
19713-2089
US

IV. Provider business mailing address

4735 OGLETOWN-STANTON ROAD MEDICAL ARTS PAVILION 2, STE 1115
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 302-292-1600
  • Fax: 302-292-8629
Mailing address:
  • Phone: 302-292-1600
  • Fax: 302-292-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberG1-0001407
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: