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General NPI Number Information
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NPI Number | 1316519044
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Entity Type | Organization
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Legal Business Name | VINOD MIRIYALA, DDS, INC.
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Dates
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Enumeration Date | 07/13/2021
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 510 E WILSON BRIDGE RD STE E
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City | WORTHINGTON
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State | OH
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Zip | 43085-2373
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Country | US
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Telephone | 877-789-8583
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Fax |
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Provider Business Mailing Address
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Address Line | 118 GRACELAND BLVD # 324
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City | COLUMBUS
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State | OH
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Zip | 43214-1530
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Country | US
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Telephone | 877-789-8583
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. VINOD MIRIYALA
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Credential | MD
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Telephone | 614-401-4415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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