Healthcare Provider Details

I. General information

NPI: 1427520360
Provider Name (Legal Business Name): JAMES MICHAEL D'AMICO D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CENTRAL AVE
FORT MYERS FL
33901-7649
US

IV. Provider business mailing address

4325 GARDEN BLVD
CAPE CORAL FL
33909-3281
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-5233
  • Fax:
Mailing address:
  • Phone: 239-204-7984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number032846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: