Provider Demographics
NPI:1598904310
Name:SUNBURY POINT DENTAL, LAURY J DIMICHAELANGELO, DDS, INC
Entity Type:Organization
Organization Name:SUNBURY POINT DENTAL, LAURY J DIMICHAELANGELO, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMICHAELANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-806-0101
Mailing Address - Street 1:5840 HERON CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8275
Mailing Address - Country:US
Mailing Address - Phone:614-899-9414
Mailing Address - Fax:614-523-4620
Practice Address - Street 1:211 E GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9791
Practice Address - Country:US
Practice Address - Phone:740-965-5050
Practice Address - Fax:740-965-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty