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General NPI Number Information
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NPI Number | 1053502047
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Entity Type | Organization
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Legal Business Name | KURUVADI DDS INC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 810 JAMACHA RD STE 205
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City | EL CAJON
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State | CA
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Zip | 92019-3223
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Country | US
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Telephone | 619-442-4141
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Fax | 619-442-3199
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Provider Business Mailing Address
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Address Line | 810 JAMACHA RD STE 205
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City | EL CAJON
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State | CA
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Zip | 92019-3223
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Country | US
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Telephone | 619-442-4141
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Fax | 619-442-3199
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SANJAY KURUVADI
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Credential | DDS
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Telephone | 619-474-1554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 42674
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License Number State | CA
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