Provider Demographics
NPI:1851509897
Name:D'AMICO, ELIO CJ (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIO
Middle Name:CJ
Last Name:D'AMICO
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 1:4901 PALM BEACH BLVD UNIT 16
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-3250
Mailing Address - Country:US
Mailing Address - Phone:239-693-0202
Mailing Address - Fax:
Practice Address - Street 1:4901 PALM BEACH BLVD UNIT 16
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-3250
Practice Address - Country:US
Practice Address - Phone:239-693-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice