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General NPI Number Information
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NPI Number | 1740235449
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Entity Type | Organization
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Legal Business Name | CHRISTIANA CENTER FOR ORAL & MAXILLOFACIAL SURGERY, P.A.
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 4133 OGLETOWN STANTON RD STE 200
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City | NEWARK
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State | DE
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Zip | 19713-4187
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Country | US
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Telephone | 130-232-8677
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Fax | 23-195-9543
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Provider Business Mailing Address
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Address Line | 4133 STANTON OGLETWN RD STE 200
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City | NEWARK
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State | DE
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Zip | 19713-4187
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Country | US
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Telephone | 302-292-1600
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Fax | 302-319-5954
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EUGENE MICHAEL DAMICO III
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Credential | D.D.S.
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Telephone | 302-292-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | G1-0000952
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License Number State | DE
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