Provider Demographics
NPI:1760677165
Name:KURUVILLA, PREETHA ACHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PREETHA
Middle Name:ACHA
Last Name:KURUVILLA
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 1:1764 GERALD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1003
Mailing Address - Country:US
Mailing Address - Phone:516-205-4181
Mailing Address - Fax:
Practice Address - Street 1:1764 GERALD AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1003
Practice Address - Country:US
Practice Address - Phone:516-205-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2007-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04892211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice