Healthcare Provider Details

I. General information

NPI: 1548254055
Provider Name (Legal Business Name): KURT A D'AMICO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 INTREPID LN
SYRACUSE NY
13205-2545
US

IV. Provider business mailing address

180 INTREPID LN
SYRACUSE NY
13205-2545
US

V. Phone/Fax

Practice location:
  • Phone: 315-446-6620
  • Fax: 315-446-6621
Mailing address:
  • Phone: 315-446-6620
  • Fax: 315-446-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: