Keerthi K Miryala, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

25845 Issued in TX

Practice address

1157 E 42ND St
Odessa, TX 79762-7723

Phone

(432) 242-6655

Fax

(832) 379-5175

NPI assigned

Oct 11, 2006

Last updated

Jun 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Andes Dental PLLC

  dba Odessa Family Dental

  • General Practice Dentistry
  • Odessa, TX
  • NPI 1346759487
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1437247897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1157 E 42ND ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797627723",
            "telephone_number": "432-242-6655",
            "fax_number": "832-379-5175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1157 E 42ND ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797627723",
            "telephone_number": "432-242-6655",
            "fax_number": "832-379-5175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5212 Cedar St",
            "address_purpose": "LOCATION",
            "city": "Bellaire",
            "state": "TX",
            "postal_code": "774013915",
            "country_code": "US",
            "telephone_number": "713-668-3677",
            "fax_number": "713-661-2597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRYALA",
        "first_name": "KEERTHI",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2024-06-12",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Michael Miller, DC
• Lisa Marie Miller, PTA
• Melissa Sue Miller, FNP
• Rebecca Dawn Miller
• Alireza Mirghiasi
• Mission Health, PLLC (Mission Health Lifestyle and Wellness Clinic)
• Gordon Ray Mitchell, HIS
• Liberty Dawn Mitchell
• Richard L Mittan, PA-C
• Modern Dental Professionals-Midland Odessa PC (Monarch Dental)

• General Practice Dentistry in Odessa, TX
• Providers in Odessa, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.