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General NPI Number Information
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NPI Number | 1215033568
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Entity Type | Individual
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Provider Name | MICHAEL E O'LEARY I D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13425 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-4608
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Country | US
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Telephone | 440-333-1177
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Fax | 216-529-2218
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Provider Business Mailing Address
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Address Line | 13425 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-4608
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Country | US
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Telephone | 440-333-1177
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Fax | 216-529-2218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21032
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License Number State | OH
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