Healthcare Provider Details

I. General information

NPI: 1841408135
Provider Name (Legal Business Name): GERMAN VILLAGE DENTAL GROUP, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 S HIGH ST
COLUMBUS OH
43206-3409
US

IV. Provider business mailing address

3974 KARL RD
COLUMBUS OH
43224-5221
US

V. Phone/Fax

Practice location:
  • Phone: 614-444-0471
  • Fax: 614-444-1091
Mailing address:
  • Phone: 614-267-5000
  • Fax: 614-267-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURY J. DIMICHAELANGELO
Title or Position: OWNER
Credential:
Phone: 614-806-2201