Provider Demographics
NPI:1003016478
Name:KURUVADI, D.D.S., INC.
Entity Type:Organization
Organization Name:KURUVADI, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KURUVADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-474-1554
Mailing Address - Street 1:1626 SWEETWATER RD STE A
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7645
Mailing Address - Country:US
Mailing Address - Phone:619-474-1554
Mailing Address - Fax:619-474-1584
Practice Address - Street 1:1626 SWEETWATER RD STE A
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7645
Practice Address - Country:US
Practice Address - Phone:619-474-1554
Practice Address - Fax:619-474-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty