Provider Demographics
NPI:1386699379
Name:DAMICO, EUGENE MICHAEL III (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:MICHAEL
Last Name:DAMICO
Suffix:III
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 1:4735 STANTON OGLETWN RD
Mailing Address - Street 2:MAP 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 STANTON OGLETWN RD
Practice Address - Street 2:MAP 2, STE. 1115
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-292-1600
Practice Address - Fax:302-292-8629
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00009521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0116093000OtherAMERIHEALTH
4300241OtherAETNA
DE0000189002Medicaid
000540991OtherHIGHMARK BLUE SHIELD
4300241OtherAETNA
DE$$$$$$$$$OtherCARE FIRST BLUE CROSS BLUE SHIELD OF DELAWARE
DE0000189002Medicaid