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General NPI Number Information
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NPI Number | 1134492945
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Entity Type | Individual
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Provider Name | DR. MICHAEL DOMENICK DAMICO
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Gender | Male
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 222 MIDDLE COUNTRY RD SUITE 316
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City | SMITHTOWN
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State | NY
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Zip | 11787-2871
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Country | US
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Telephone | 631-724-4747
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Fax | 631-780-6528
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Provider Business Mailing Address
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Address Line | 222 E MAIN ST STE 316
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City | SMITHTOWN
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State | NY
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Zip | 11787-2814
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Country | US
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Telephone | 631-724-4747
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Fax | 631-780-6528
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 043141
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License Number State | NY
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