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General NPI Number Information
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NPI Number | 1598904310
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Entity Type | Organization
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Legal Business Name | SUNBURY POINT DENTAL, LAURY J DIMICHAELANGELO, DDS, INC
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 211 E GRANVILLE ST
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City | SUNBURY
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State | OH
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Zip | 43074-9791
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Country | US
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Telephone | 740-965-5050
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Fax | 740-965-4527
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Provider Business Mailing Address
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Address Line | 5840 HERON CT
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City | WESTERVILLE
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State | OH
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Zip | 43082-8275
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Country | US
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Telephone | 614-899-9414
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Fax | 614-523-4620
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | PAMELA J DIMICHAELANGELO
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Credential |
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Telephone | 614-806-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18047
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License Number State | OH
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