Provider Demographics
NPI:1376578302
Name:ANGELO DEFALCO
Entity Type:Organization
Organization Name:ANGELO DEFALCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEFALCO
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:614-866-5770
Mailing Address - Street 1:6116 MCNAUGHTEN CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232
Mailing Address - Country:US
Mailing Address - Phone:614-866-5770
Mailing Address - Fax:614-866-4777
Practice Address - Street 1:6116 MCNAUGHTEN CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232
Practice Address - Country:US
Practice Address - Phone:614-866-5770
Practice Address - Fax:614-866-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty