Provider Demographics
NPI:1285719443
Name:DIGAMON, DENNIS SY (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:SY
Last Name:DIGAMON
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 1:1408 W REYNOLDS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4361
Mailing Address - Country:US
Mailing Address - Phone:813-752-7477
Mailing Address - Fax:
Practice Address - Street 1:1408 W REYNOLDS ST
Practice Address - Street 2:SUITE C
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4361
Practice Address - Country:US
Practice Address - Phone:813-752-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00121441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice