Provider Demographics
NPI:1942340633
Name:KURUVADI, SANJAY (DDS - ORTHODONTIST)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:KURUVADI
Suffix:
Gender:M
Credentials:DDS - ORTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 SWEETWATER RD
Mailing Address - Street 2:SUITE # A
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
Practice Address - Street 2:SUITE # A
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics