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General NPI Number Information
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NPI Number | 1215069208
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Entity Type | Organization
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Legal Business Name | CHARLES A. D'AMICO, D.D.S., P.A.
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3900 CLARK RD BLDG H, SUITE 5
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City | SARASOTA
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State | FL
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Zip | 34233-2301
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Country | US
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Telephone | 941-921-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 CLARK RD BLDG H, SUITE 5
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City | SARASOTA
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State | FL
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Zip | 34233-2301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES D'AMICO
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Credential | D.D.S.
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Telephone | 941-921-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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