Provider Demographics
NPI:1598826653
Name:D'AMICO, SEBASTIAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:
Last Name:D'AMICO
Suffix:JR
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 1:2116 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WANAMASSA
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-775-1510
Mailing Address - Fax:732-775-1513
Practice Address - Street 1:2116 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WANAMASSA
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:732-775-1510
Practice Address - Fax:732-775-1513
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist