Provider Demographics
NPI:1669688396
Name:SAMMARCO, DONALD JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOSEPH
Last Name:SAMMARCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 WINTER SPRINGS BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9358
Mailing Address - Country:US
Mailing Address - Phone:407-365-9772
Mailing Address - Fax:407-365-6918
Practice Address - Street 1:2200 WINTER SPRINGS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9358
Practice Address - Country:US
Practice Address - Phone:407-365-9772
Practice Address - Fax:407-365-6918
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60278OtherBLUE CROSS BLUE SHIELD