MEDICARE: KURUVADI DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	42674	CA

General Provider Information

NPI Number	:	1053502047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KURUVADI DDS INC

Provider Business Mailing Address
First Line	:	810 JAMACHA RD STE 205
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3223
Country	:	US
Telephone Number	:	619-442-4141
Fax Number	:	619-442-3199

Provider Business Practice Location Address
First Line	:	810 JAMACHA RD STE 205
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3223
Country	:	US
Telephone Number	:	619-442-4141
Fax Number	:	619-442-3199

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. SANJAY KURUVADI
Credential	:	DDS
Telephone Number	:	619-474-1554

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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