Daniel Kuruvilla
Dentist, Pediatric Dentistry in Yulee, FL. Individual provider (NPI-1).
NPI number1902482003
StatusActive
Last updated in NPPESSep 1, 2023
Details
- NPI
- 1902482003
- Entity type
- Individual (NPI-1)
- Name
- Daniel Kuruvilla
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 20, 2021
- Certification date
- Aug 8, 2021
- Last updated
- Sep 1, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0221X | Dentist, Pediatric Dentistry | DN26484 | FL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
463725 State Road 200 Ste 3Yulee, FL 32097-8671
Phone 904-584-9004 · Fax 904-347-2611
Mailing address
625 Elmwood AveRochester, NY 14620-2913
Other practice locations
196 Everest Ln Ste 1
Saint Johns, FL 32259-4103
Saint Johns, FL 32259-4103
Phone 904-584-9004
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