Provider Demographics
NPI:1295822781
Name:VANDAMIA, ERIC MATTHEW (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MATTHEW
Last Name:VANDAMIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 KEYSTONE DRIVE
Mailing Address - Street 2:ERIC M VANDAMIA DMD PC
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:814-866-2580
Practice Address - Street 1:2181 KEYSTONE DRIVE
Practice Address - Street 2:ERIC M VANDAMIA DMD PC
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:814-866-2580
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0310571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice