Healthcare Provider Details

I. General information

NPI: 1962426759
Provider Name (Legal Business Name): ANTHONY JOSEPH D'AMICO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CANAL ST
LYONS NY
14489-1249
US

IV. Provider business mailing address

20 CANAL ST
LYONS NY
14489-1249
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-4000
  • Fax: 315-946-0263
Mailing address:
  • Phone: 315-946-4000
  • Fax: 315-946-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: