Provider Demographics
NPI:1972948198
Name:D'AMICO, MICHAEL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN-STANTON ROAD
Mailing Address - Street 2:MEDICAL ARTS PAVILION 2, STE 1115
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-292-1600
Mailing Address - Fax:302-292-8629
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 1115
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2089
Practice Address - Country:US
Practice Address - Phone:302-292-1600
Practice Address - Fax:302-292-8629
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00014071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery