Healthcare Provider Details

I. General information

NPI: 1316519044
Provider Name (Legal Business Name): VINOD MIRIYALA, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E WILSON BRIDGE RD STE E
WORTHINGTON OH
43085-2373
US

IV. Provider business mailing address

118 GRACELAND BLVD # 324
COLUMBUS OH
43214-1530
US

V. Phone/Fax

Practice location:
  • Phone: 877-789-8583
  • Fax:
Mailing address:
  • Phone: 877-789-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINOD MIRIYALA
Title or Position: CEO
Credential: MD
Phone: 614-401-4415