Healthcare Provider Details

I. General information

NPI: 1225055940
Provider Name (Legal Business Name): VINOD MIRIYALA DDS, BDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N BREIEL BLVD UNIT B
MIDDLETOWN OH
45042-3899
US

IV. Provider business mailing address

PO BOX 837
HAMILTON OH
45012-0837
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-1111
  • Fax:
Mailing address:
  • Phone: 513-454-1111
  • Fax: 740-532-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30-023190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: