Healthcare Provider Details

I. General information

NPI: 1821197229
Provider Name (Legal Business Name): HETAL V VAIDYA D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W HUBBARD AVE
COLUMBUS OH
43215-1474
US

IV. Provider business mailing address

CMR 442 HEIDELBERG DENTAL ACTIVITY CREDENTIALS OFFICE
APO AE
09042
US

V. Phone/Fax

Practice location:
  • Phone: 614-258-3880
  • Fax: 614-252-5873
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.026860
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: