Jacob Jose Kuruvilla, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

33117 Issued in TX

Practice address

1110 S Cesar Chavez Blvd Apt 3050
Dallas, TX 75201-6089

Phone

(631) 742-9840

NPI assigned

Jun 14, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1164952032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11613 N CENTRAL EXPY STE 111A",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752433808",
            "telephone_number": "631-742-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 S CESAR CHAVEZ BLVD APT 3050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752016089",
            "telephone_number": "631-742-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KURUVILLA",
        "first_name": "JACOB",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-14",
        "last_updated": "2022-07-21",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS041245",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "33117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tori Kurth, NP
• Brian Rudolph Kurtz, MD
• Mallika Kuruba, MD
• Sunil Kurup, M.D.
• Snoben Kuruvila, PA-C
• Shinu Kuruvilla, PHARMD
• Andrew Christopher Kurz, OTR/L
• Karl Wilhelm Kurz, MD
• Kathleen Morgan Kusey, PHARMD
• Igor Kushner, MD

• Dentist in Dallas, TX
• Providers in Dallas, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.