Healthcare Provider Details

I. General information

NPI: 1295713915
Provider Name (Legal Business Name): LAURY J DIMICHAELANGELO DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/02/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3974 KARL RD
COLUMBUS OH
43224-5221
US

IV. Provider business mailing address

3974 KARL RD
COLUMBUS OH
43224-5221
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-5000
  • Fax: 614-267-0541
Mailing address:
  • Phone: 614-267-5000
  • Fax: 614-267-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number20286
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number21189
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18047
License Number StateOH

VIII. Authorized Official

Name: DR. LAURY D DIMICHAELANGELO
Title or Position: PRESIDENT DENTIST
Credential: DDS
Phone: 614-267-5000