Healthcare Provider Details

I. General information

NPI: 1811796386
Provider Name (Legal Business Name): DR. EVA MANDYBUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S HIGH ST
COLUMBUS OH
43215-4502
US

IV. Provider business mailing address

145 W 2ND AVE
COLUMBUS OH
43201-3408
US

V. Phone/Fax

Practice location:
  • Phone: 614-461-4600
  • Fax:
Mailing address:
  • Phone: 513-516-7305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028066
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: