Provider Demographics
NPI:1891908414
Name:SEBASTIAN D'AMICO, JR., D.M.D,, P.A.
Entity Type:Organization
Organization Name:SEBASTIAN D'AMICO, JR., D.M.D,, P.A.
Other - Org Name:SUNSET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-804-4317
Mailing Address - Street 1:2116 SUNSET AVENUE
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:
Practice Address - Street 1:2116 SUNSET AVENUE
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO17056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty