Provider Demographics
NPI:1053502047
Name:KURUVADI DDS INC
Entity Type:Organization
Organization Name:KURUVADI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
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 1:810 JAMACHA RD STE 205
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3223
Mailing Address - Country:US
Mailing Address - Phone:619-442-4141
Mailing Address - Fax:619-442-3199
Practice Address - Street 1:810 JAMACHA RD STE 205
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3223
Practice Address - Country:US
Practice Address - Phone:619-442-4141
Practice Address - Fax:619-442-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty