Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 032846 | NY |
NPI | 1427520360 |
---|---|
Provider Name | Dr. James Michael D'amico |
First Address | Cape Coral, FL 33909-3281 |
Second Address | Fort Myers, FL 33901-7649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2018 |
Last Update Date | 17/12/2018 |