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NPI Code Detail

MEDICARE: DR. LAURY J DIMICHAELANGELO D.D.S.

MEDICARE: DR. LAURY J DIMICHAELANGELO D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry18047OH

General Provider Information

NPI Number : 1992898506
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURY J DIMICHAELANGELO D.D.S.
Provider Business Mailing Address
First Line : 3974 KARL RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43224-5221
Country : US
Telephone Number : 614-267-5000
Fax Number : 614-267-0541
Provider Business Practice Location Address
First Line : 3974 KARL RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43224-5221
Country : US
Telephone Number : 614-267-5000
Fax Number : 614-267-0541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 07/08/2007

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