Provider Demographics
NPI:1215033568
Name:O'LEARY, MICHAEL E I (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:O'LEARY
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13425 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4608
Mailing Address - Country:US
Mailing Address - Phone:440-333-1177
Mailing Address - Fax:216-529-2218
Practice Address - Street 1:13425 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4608
Practice Address - Country:US
Practice Address - Phone:440-333-1177
Practice Address - Fax:216-529-2218
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist