Provider Demographics
NPI:1295836658
Name:DAMELIO, STEVEN GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GEORGE
Last Name:DAMELIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 ANGELS PATH
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2293
Mailing Address - Country:US
Mailing Address - Phone:585-787-1175
Mailing Address - Fax:585-738-0067
Practice Address - Street 1:1794 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2124
Practice Address - Country:US
Practice Address - Phone:585-381-2310
Practice Address - Fax:585-381-6709
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42497-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist