Healthcare Provider Details

I. General information

NPI: 1396266706
Provider Name (Legal Business Name): IOANNIS PILALAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-0371
  • Fax: 614-292-4612
Mailing address:
  • Phone: 614-292-4927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberRES.003803
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: