Provider Demographics
NPI:1225055940
Name:MIRIYALA, VINOD (DDS, BDS, MPH)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:
Last Name:MIRIYALA
Suffix:
Gender:M
Credentials:DDS, BDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6078
Mailing Address - Country:US
Mailing Address - Phone:513-454-1460
Mailing Address - Fax:740-532-4859
Practice Address - Street 1:601 N BREIEL BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3899
Practice Address - Country:US
Practice Address - Phone:513-454-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019042122300000X
OH30-023190122300000X, 1223P0221X
WV3894122300000X
WV341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018398Medicaid
OH3057883Medicaid
KY7100236110Medicaid