Provider Demographics
NPI:1316519044
Name:VINOD MIRIYALA, DDS, INC.
Entity type:Organization
Organization Name:VINOD MIRIYALA, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRIYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-401-4415
Mailing Address - Street 1:118 GRACELAND BLVD # 324
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1530
Mailing Address - Country:US
Mailing Address - Phone:877-789-8583
Mailing Address - Fax:
Practice Address - Street 1:510 E WILSON BRIDGE RD STE E
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2373
Practice Address - Country:US
Practice Address - Phone:877-789-8583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty