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General NPI Number Information
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NPI Number | 1891908414
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Entity Type | Organization
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Legal Business Name | SEBASTIAN D'AMICO, JR., D.M.D,, P.A.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 2116 SUNSET AVENUE
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City | WANAMASSA
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State | NJ
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Zip | 07712
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Country | US
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Telephone | 732-775-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 2116 SUNSET AVENUE
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City | WANAMASSA
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State | NJ
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Zip | 07712
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Country | US
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Telephone | 732-775-1510
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEBASTIAN JOSEPH D'AMICO JR.
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Credential | D.M.D.
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Telephone | 732-804-4317
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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 | DIO17056
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License Number State | NJ
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