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NPI Code Detail

MEDICARE: DR. ELIO C.J. D'AMICO D.D.S.

MEDICARE: DR. ELIO C.J. D'AMICO D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN15639FL

General Provider Information

NPI Number : 1851509897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIO C.J. D'AMICO D.D.S.
Provider Business Mailing Address
First Line : 4901 PALM BEACH BLVD UNIT 16
Second Line :
City : FORT MYERS
State : FL
Zip : 33905-3250
Country : US
Telephone Number : 239-693-0202
Fax Number :
Provider Business Practice Location Address
First Line : 4901 PALM BEACH BLVD UNIT 16
Second Line :
City : FORT MYERS
State : FL
Zip : 33905-3250
Country : US
Telephone Number : 239-693-0202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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