Provider Demographics
NPI:1063601953
Name:ERIC VAN DAMIA DMD PC
Entity type:Organization
Organization Name:ERIC VAN DAMIA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN DAMIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-866-2550
Mailing Address - Street 1:2181 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509
Mailing Address - Country:US
Mailing Address - Phone:814-866-2550
Mailing Address - Fax:874-866-2580
Practice Address - Street 1:2181 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509
Practice Address - Country:US
Practice Address - Phone:814-866-2550
Practice Address - Fax:874-866-2580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIC M VAN DAMIA DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031057L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty