Provider Demographics
NPI:1821197229
Name:VAIDYA, HETAL V (DDS)
Entity Type:Individual
Prefix:DR
First Name:HETAL
Middle Name:V
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442
Mailing Address - Street 2:HEIDELBERG DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 W HUBBARD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1474
Practice Address - Country:US
Practice Address - Phone:614-258-3880
Practice Address - Fax:614-252-5873
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0268601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2982107Medicaid