DR. RYAN MASAO MIZUMOTO (NPI# 1578793006) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578793006 |
| Entity Type | Individual |
| Full Name | DR. RYAN MASAO MIZUMOTO |
| Credential | DMD |
| Practice Address |
55 Caren Ave Ste 270 Worthington OH 43085-2515 |
| Mailing Address |
6779 Oakfair Ave Columbus OH 43235-2734 |
| Practice Telephone | 6148857721 |
| Practice Fax Number | 6148880284 |
| Mailing Telephone | 2069206173 |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2019-01-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 019028088 | IL | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
30-023250 | OH | Dental Providers |
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
30-023250 | OH | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7393 Broadview Rd Ste E, Seven Hills, OH 441314445 | 2165242499 | 2165241807 |
| 5155 Bradenton Ave Ste 110, Dublin, OH 430177559 | 6147980083 |
| Street Address |
55 CAREN AVE STE 270 |
| City | WORTHINGTON |
| State | OH |
| Zip Code | 43085-2515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073779575 | Bradley A Purcell | Dentist | 55 Caren Ave Ste 270, Worthington, OH 43085-2515 | 2008-08-04 |
| 1932631884 | Hyunok Cindy Jo | Dentist | 55 Caren Ave Ste 270, Worthington, OH 43085-2515 | 2017-03-30 |
| 1912250135 | Bradley A Purcell D.d.s. M.s. & Ryan M. Mizumoto D.m.d., M.s., Inc | Dentist | 55 Caren Ave Ste 270, Worthington, OH 43085-2515 | 2012-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750901468 | Natalia Tehan | Technician | 6417 Linworth Rd, Worthington, OH 43085 | 2020-04-22 |
| 1114546033 | Shelby Kaye Breneman | Case Manager/Care Coordinator | 445 E. Dublin Gradville Rd., Worthington, OH 43085 | 2020-04-10 |
| 1366919144 | Halle Kleiber | Behavior Technician | 455 E Dublin Granville Road, Worthington, OH 43085 | 2018-10-30 |
| 1184119943 | Debbie Elizabeth Costello | Foster Care Agency | 5655 North High St., Columbus, OH 43085 | 2018-06-25 |
| 1700389186 | Audrey Kathryn Eichenlaub | Dentist | 6641 N High St Ste 101, Worthington, OH 43085 | 2018-03-13 |
| 1568971828 | Sharon Cooley-burdine | Registered Nurse | 495 Englander Court, Worthington, OH 43085 | 2017-09-29 |
| 1487183885 | Kathleen Marie Hussein | Social Worker | 445 East Dublin-granville Road, Columbus, OH 43085 | 2017-06-08 |
| 1760910459 | Eileen Marie Butler | Physical Therapist | 200 East Wilson Bridge, Worthington, OH 43085 | 2017-05-25 |
| 1346692431 | Julie H. Richards | Counselor | 870 High Street, Suite 203, Worthington, OH 43085 | 2016-07-12 |
| 1922452796 | Penny Anne Coons | Pharmacist | 866 Loch Lomond Lane, Worthington, OH 43085 | 2016-04-19 |
| Find all providers in zip 43085 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073779575 | Bradley A Purcell | Dentist | 55 Caren Ave Ste 270, Worthington, OH 43085-2515 | 2008-08-04 |
| 1932631884 | Hyunok Cindy Jo | Dentist | 55 Caren Ave Ste 270, Worthington, OH 43085-2515 | 2017-03-30 |
| 1912250135 | Bradley A Purcell D.d.s. M.s. & Ryan M. Mizumoto D.m.d., M.s., Inc | Dentist | 55 Caren Ave Ste 270, Worthington, OH 43085-2515 | 2012-10-25 |
| 1952331456 | Richard Pratt Cunningham | Dentist | 7227 N High St, Suite 1, Worthington, OH 43085-2343 | 2006-07-03 |
| 1659300572 | Kim Allen Laurell | Dentist | 55 Caren Avenue, Suite 270, Worthington, OH 43085 | 2006-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649887670 | Hanin Hammoudeh | Dentist | 305 W 12th Ave # 3005s, Columbus, OH 43210-1267 | 2020-09-24 |
| 1235785957 | Diogo Do Nascimento Machado Gouveia | Dentist | 305 W 12th Ave Ofc 3005d, Columbus, OH 43210-1267 | 2019-08-19 |
| 1275060196 | Robert James Faulkner | Dentist | 5391 Grand Legacy Dr, Maineville, OH 45039-7783 | 2017-05-23 |
| 1225333875 | Manish Chopra Dmd Inc. | Dentist | 2752 Erie Ave Ste 1, Cincinnati, OH 45208-2207 | 2011-01-12 |
| 1164732871 | Burak Yilmaz | Dentist | 305 W12th Ave. Postle Hall, The Ohio State University College of Dentistry, Columbus, OH 43210 | 2010-10-15 |
| 1194054650 | Sanjay Karunagaran | Dentist | 5155 Buehlers Dr Ste 107, Medina, OH 44256-5389 | 2009-12-12 |
| 1073769204 | Meckler Dental Providers (macedonia), Inc. | Dentist | 8210 Macedonia Commons, Unit #6, Macedonia, OH 44056-1860 | 2008-08-07 |
| 1619173994 | Charles Vito Caponigro | Dentist | 460 S State St, Westerville, OH 43081-2922 | 2007-06-25 |
| 1730394594 | Mark Steven Bello | Dentist | 1816 Columbus Pike, Delaware, OH 43015-2728 | 2007-05-14 |
| 1619189602 | Roland Paul Pagniano Jr. | Dentist | 6805 Avery-muirfield Drive, Suite 201, Dublin, OH 43016-7184 | 2007-05-04 |
| Find all providers with the same taxonomy | ||||
| City | WORTHINGTON |
| Zip Code | 43085 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.