Provider Demographics
NPI:1720205180
Name:DAMON, DARRYL E (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:E
Last Name:DAMON
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 1:55 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4789
Mailing Address - Country:US
Mailing Address - Phone:863-675-0019
Mailing Address - Fax:863-675-1400
Practice Address - Street 1:55 BELMONT ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4789
Practice Address - Country:US
Practice Address - Phone:863-675-0019
Practice Address - Fax:863-675-1400
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 10898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist